Provider Demographics
NPI:1861213373
Name:LONG COAST MEDICAL PLLC
Entity type:Organization
Organization Name:LONG COAST MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:WAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-813-6391
Mailing Address - Street 1:10 SHERRY HILL LN
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3221
Mailing Address - Country:US
Mailing Address - Phone:718-813-6391
Mailing Address - Fax:
Practice Address - Street 1:13636 39TH AVE STE 7
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5576
Practice Address - Country:US
Practice Address - Phone:718-813-6391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-18
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty