Provider Demographics
NPI:1053475160
Name:COSTIN, ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:COSTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3521
Mailing Address - Country:US
Mailing Address - Phone:609-924-9300
Mailing Address - Fax:609-430-9481
Practice Address - Street 1:419 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3521
Practice Address - Country:US
Practice Address - Phone:609-924-9300
Practice Address - Fax:609-430-9481
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05926000207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1273024OtherUNITED-HCARE-SPECIALTY
NJMES081OtherOXFORD SPECIALTY
NJ110137121OtherRAILROAD MED.-PRINCETON
NJ0644510000OtherAMERI-IBC SPEC.
NJ5572509Medicaid
NJ740065OtherAMERIHLTH ADMIN SPECIALTY
NJ883596OtherAETNA-SPECIALTY
NJ110137137OtherRAILROAD MED.-MONROE
NJ1273024OtherUNITED-HCARE-SPECIALTY
NJ740065OtherAMERIHLTH ADMIN SPECIALTY