Healthcare Provider Details

I. General information

NPI: 1730300856
Provider Name (Legal Business Name): COASTAL FOOT & ANKLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 ROUTE 72 W SUITE 307
MANAHAWKIN NJ
08050-2468
US

IV. Provider business mailing address

1100 ROUTE 72 WEST SUITE 307
MANAHAWKIN NJ
08050
US

V. Phone/Fax

Practice location:
  • Phone: 609-597-5515
  • Fax: 609-597-6789
Mailing address:
  • Phone: 609-597-5515
  • Fax: 609-597-6789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00277600
License Number StateNJ

VIII. Authorized Official

Name: DR. THOMAS LEMBO JR.
Title or Position: OWNER
Credential: DPM
Phone: 609-597-5515