Provider Demographics
NPI:1205983939
Name:COSTIGAN, RONALD B (DC)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:B
Last Name:COSTIGAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7312 VENTNOR AVE
Mailing Address - Street 2:
Mailing Address - City:VENTNOR CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08406-1957
Mailing Address - Country:US
Mailing Address - Phone:609-487-5969
Mailing Address - Fax:
Practice Address - Street 1:1 HOPE CORSON RD
Practice Address - Street 2:
Practice Address - City:OCEAN VIEW
Practice Address - State:NJ
Practice Address - Zip Code:08230-1319
Practice Address - Country:US
Practice Address - Phone:609-545-0445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00556300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8459509Medicaid
NJ45641Medicare ID - Type Unspecified
NJ68936Medicare UPIN