Healthcare Provider Details

I. General information

NPI: 1982924080
Provider Name (Legal Business Name): COASTAL ENDOSCOPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 06/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 GUNNING RIVER RD
BARNEGAT NJ
08005-1436
US

IV. Provider business mailing address

175 GUNNING RIVER RD BUILDING A, UNIT 4
BARNEGAT NJ
08005-1436
US

V. Phone/Fax

Practice location:
  • Phone: 609-654-6525
  • Fax: 609-981-9078
Mailing address:
  • Phone: 609-654-6525
  • Fax: 609-981-9078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NEAL J WINZELBERG
Title or Position: MD
Credential:
Phone: 609-654-6525