Theodore A. Dacosta Md Pa

NPI 1295978385 - Internal Medicine - 207RG0100X

NPI Details
NPI 1295978385
Enumeration Date 04/20/2009
Last Updated 04/20/2009
Entity Type Healthcare Provider
Active Over 7 years ago
Authorized Information
Name THEODORE ANTHONY THEODORE
Position PRESIDENT
Phone (973) 422-0094
Fax (973) 422-9895
Practice Location
22 CHESTNUT ST
LIVINGSTON NJ, 07039-5502, US
Phone (973) 422-0094
Fax (973) 422-9895
Business Location
22 CHESTNUT ST
LIVINGSTON NJ, 07039-5502, US
Phone (973) 422-0094
Fax (973) 422-9895
Toxanomy
Taxonomy Code 207RG0100X
License State New Jersey
License Number MA56002
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According to our database, Theodore A. Dacosta Md Pa NPI is 1295978385, taxonomy code is 207RG0100X and license number is MA56002, license state is located at New Jersey. Theodore A. Dacosta Md Pa physically located at 22 Chestnut St, Livingston NJ, 07039-5502. NPI Number 1033115704 has the healthcare provider type.

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1295978385 NPI number is provided on an as is basis without warranty of any kind. 1295978385 is maintained by the National Plan & Provider Enumeration System. The contents of Theodore A. Dacosta Md Pa are for informational purposes only.