Provider Demographics
NPI:1568035103
Name:COSTA, JOSEPH M
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:COSTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 TAVISTOCK BLVD
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-3960
Mailing Address - Country:US
Mailing Address - Phone:908-692-9604
Mailing Address - Fax:
Practice Address - Street 1:331 TAVISTOCK BLVD
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-3960
Practice Address - Country:US
Practice Address - Phone:908-692-9604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374700000XNursing Service Related ProvidersTechnicianGroup - Single Specialty