Coastal Pediatrics LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MAO58076 Issued in NJ

Legal business name

COASTAL PEDIATRICS LLC

Practice address

25 N County Line Rd
Jackson, NJ 08527-1270

Phone

(732) 905-9855

Fax

(732) 905-9860

NPI assigned

Mar 2, 2007

Last updated

Sep 25, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Tehsin Qudsi, MD

Title

Owner

Phone

(732) 905-9855

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348531200000",
    "number": "1184752768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 N COUNTY LINE RD",
            "city": "JACKSON",
            "state": "NJ",
            "postal_code": "085271270",
            "telephone_number": "732-905-9855",
            "fax_number": "732-905-9860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 N COUNTY LINE RD",
            "city": "JACKSON",
            "state": "NJ",
            "postal_code": "085271270",
            "telephone_number": "732-905-9855",
            "fax_number": "732-905-9860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL PEDIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-02",
        "last_updated": "2012-09-25",
        "status": "A",
        "authorized_official_last_name": "QUDSI",
        "authorized_official_first_name": "TEHSIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-905-9855",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "MAO58076",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5293707",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.