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General NPI Number Information
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NPI Number | 1699893925
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Entity Type | Organization
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Legal Business Name | SHORELINE SURGICAL ASSOC. P.C.
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 05/02/2016
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Provider Practice Location Address
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Address Line | 400 SAYBROOK RD SUITE 110
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City | MIDDLETOWN
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State | CT
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Zip | 06457
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Country | US
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Telephone | 860-347-9167
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Fax | 860-347-1630
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Provider Business Mailing Address
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Address Line | 400 SAYBROOK RD SUITE 110
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City | MIDDLETOWN
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State | CT
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Zip | 06457
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Country | US
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Telephone | 860-347-9167
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Fax | 860-347-1630
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSEPH A COATTI
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Credential | MD
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Telephone | 860-347-9167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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