Provider Demographics
NPI:1730300856
Name:COASTAL FOOT & ANKLE, LLC
Entity type:Organization
Organization Name:COASTAL FOOT & ANKLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMBO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:609-597-5515
Mailing Address - Street 1:1100 ROUTE 72 WEST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050
Mailing Address - Country:US
Mailing Address - Phone:609-597-5515
Mailing Address - Fax:609-597-6789
Practice Address - Street 1:1100 ROUTE 72 W
Practice Address - Street 2:SUITE 307
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2468
Practice Address - Country:US
Practice Address - Phone:609-597-5515
Practice Address - Fax:609-597-6789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00277600213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ077744S6UMedicare UPIN
NJ083524Medicare ID - Type Unspecified
NJ5482480001Medicare NSC