Provider Demographics
NPI:1063828721
Name:COAST TO COAST WOUND CARE SURGEONS INC
Entity type:Organization
Organization Name:COAST TO COAST WOUND CARE SURGEONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:G
Authorized Official - Last Name:BUNKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-237-6797
Mailing Address - Street 1:941 MCLEAN AVE
Mailing Address - Street 2:SUITE 387
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-4107
Mailing Address - Country:US
Mailing Address - Phone:914-237-6797
Mailing Address - Fax:914-237-6790
Practice Address - Street 1:4411 N HABANA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7211
Practice Address - Country:US
Practice Address - Phone:813-872-2771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-02
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty