Provider Demographics
NPI:1811919178
Name:COELHO D'COSTA, VINETTE (MD)
Entity type:Individual
Prefix:
First Name:VINETTE
Middle Name:
Last Name:COELHO D'COSTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 RARITAN AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2901
Mailing Address - Country:US
Mailing Address - Phone:908-333-6150
Mailing Address - Fax:855-939-2043
Practice Address - Street 1:503 RARITAN AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2901
Practice Address - Country:US
Practice Address - Phone:908-333-6150
Practice Address - Fax:908-333-6154
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07503900207R00000X, 207RP1001X, 207LC0200X, 207RS0012X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI41355Medicare UPIN