Healthcare Provider Details

I. General information

NPI: 1801189337
Provider Name (Legal Business Name): COASTAL ANESTHESIA SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 MEADOWLANDS PKWY
SECAUCUS NJ
07094-2311
US

IV. Provider business mailing address

210 MEADOWLANDS PKWY
SECAUCUS NJ
07094-2311
US

V. Phone/Fax

Practice location:
  • Phone: 908-653-9399
  • Fax: 908-653-9305
Mailing address:
  • Phone: 908-653-9399
  • Fax: 908-653-9305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: KIERON W GREAVES
Title or Position: OWNER
Credential: MD
Phone: 908-653-9399