Healthcare Provider Details

I. General information

NPI: 1568576908
Provider Name (Legal Business Name): EAST COAST MEDICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 NW 10TH AVE SUITE 205
BOCA RATON FL
33486-1312
US

IV. Provider business mailing address

1500 NW 10TH AVE SUITE 205
BOCA RATON FL
33486-1312
US

V. Phone/Fax

Practice location:
  • Phone: 561-391-1085
  • Fax: 561-391-1449
Mailing address:
  • Phone: 561-391-1085
  • Fax: 561-391-1449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: DR. BRYAN SHAUN VINIK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 561-391-1085