Provider Demographics
NPI:1639254634
Name:COSTA, GERMAN H (MD)
Entity Type:Individual
Prefix:DR
First Name:GERMAN
Middle Name:H
Last Name:COSTA
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 1:3196 KENNEDY BLVD
Mailing Address - Street 2:MAILBOX 16A
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-2436
Mailing Address - Country:US
Mailing Address - Phone:201-795-9080
Mailing Address - Fax:201-795-9434
Practice Address - Street 1:3196 KENNEDY BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-2436
Practice Address - Country:US
Practice Address - Phone:201-795-9080
Practice Address - Fax:201-795-9434
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07273600208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
5538HOtherEMPIRE
3007104OtherAETNA
P3453578OtherOXFORD
6718749OtherCIGNA
NJ9048901Medicaid
5538HOtherEMPIRE
H78728Medicare UPIN