Provider Demographics
NPI:1528466919
Name:COASTAL DERMATOLOGY LLC
Entity type:Organization
Organization Name:COASTAL DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:OSMUNDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-836-1600
Mailing Address - Street 1:198 JACK MARTIN BLVD.
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724
Mailing Address - Country:US
Mailing Address - Phone:732-836-1600
Mailing Address - Fax:732-836-1601
Practice Address - Street 1:198 JACK MARTIN BLVD.
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724
Practice Address - Country:US
Practice Address - Phone:732-836-1600
Practice Address - Fax:732-836-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-17
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty