Healthcare Provider Details

I. General information

NPI: 1841717808
Provider Name (Legal Business Name): COASTAL PEDIATRIC ORTHOPEDICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 11/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 LACEY RD STE 2
FORKED RIVER NJ
08731-1200
US

IV. Provider business mailing address

PO BOX 359
LONG BRANCH NJ
07740-0359
US

V. Phone/Fax

Practice location:
  • Phone: 732-403-3395
  • Fax:
Mailing address:
  • Phone: 732-403-3395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier1457593261
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerNPI

VIII. Authorized Official

Name: CHRISTOS PLAKAS
Title or Position: OWNER
Credential: MD
Phone: 732-403-3395