Provider Demographics
NPI:1225379308
Name:COSTA MEDICAL
Entity Type:Organization
Organization Name:COSTA MEDICAL
Other - Org Name:ABDOMINAL DEVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PODOLSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-558-4254
Mailing Address - Street 1:32 NASSAU ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08542-4503
Mailing Address - Country:US
Mailing Address - Phone:609-558-4254
Mailing Address - Fax:609-921-8651
Practice Address - Street 1:32 NASSAU ST
Practice Address - Street 2:SUITE 300
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08542-4503
Practice Address - Country:US
Practice Address - Phone:609-558-4254
Practice Address - Fax:609-921-8651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0400359534332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
QDTJG2TY5OtherACCREDITATION AWARD