Healthcare Provider Details

I. General information

NPI: 1013025337
Provider Name (Legal Business Name): COASTAL NEPHROLOGY AND HYPERTENSION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2006
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 VILLAGE DR
CAPE MAY COURT HOUSE NJ
08210-1939
US

IV. Provider business mailing address

PO BOX 56
CAPE MAY COURT HOUSE NJ
08210-0056
US

V. Phone/Fax

Practice location:
  • Phone: 609-463-2755
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number25MB07515600
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierDF7230
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerRAILROAD MEDICARE
# 2
Identifier0116629
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: DR. MELIND R PANDYA
Title or Position: OWNER
Credential: DO
Phone: 609-463-2755