Provider Demographics
NPI:1245317346
Name:EAST COAST ORTHOPAEDIC & SPORTS MEDICINE,LLC
Entity type:Organization
Organization Name:EAST COAST ORTHOPAEDIC & SPORTS MEDICINE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIAND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-748-2922
Mailing Address - Street 1:44 E JIMMIE LEEDS RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9599
Mailing Address - Country:US
Mailing Address - Phone:609-748-2922
Mailing Address - Fax:609-748-2911
Practice Address - Street 1:MEDICAL ARTS PAVILION
Practice Address - Street 2:RT 72 WEST #306
Practice Address - City:MANAHQWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050
Practice Address - Country:US
Practice Address - Phone:609-748-2922
Practice Address - Fax:609-748-2911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ101695Medicare ID - Type Unspecified