Provider Demographics
NPI:1629048137
Name:COSTA, PETER (DPM)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:COSTA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 LIBERTY SQUARE MALL
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980-2400
Mailing Address - Country:US
Mailing Address - Phone:845-429-0520
Mailing Address - Fax:845-429-0603
Practice Address - Street 1:7 LIBERTY SQUARE MALL
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NY
Practice Address - Zip Code:10980-2400
Practice Address - Country:US
Practice Address - Phone:845-429-0520
Practice Address - Fax:845-429-0603
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN39101213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00901804Medicaid
NYP41041OtherEMPIRE BCBS
NYP41041Medicare PIN
NY00901804Medicaid