Healthcare Provider Details

I. General information

NPI: 1558657874
Provider Name (Legal Business Name): EAST COAST INSTITUTE FOR RESEARCH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 06/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11701-32 SAN JOSE BLVD. SUITE 108
JACKSONVILLE FL
32223-1884
US

IV. Provider business mailing address

11701-32 SAN JOSE BLVD. SUITE 108
JACKSONVILLE FL
32223-1884
US

V. Phone/Fax

Practice location:
  • Phone: 904-854-1354
  • Fax: 904-854-1355
Mailing address:
  • Phone: 904-854-1354
  • Fax: 904-854-1355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License NumberPS37778
License Number StateFL

VIII. Authorized Official

Name: DR. BENJAMIN EPSTEIN
Title or Position: PRESIDENT/CEO
Credential: PHARMD
Phone: 904-854-1354