MEDICARE: DR. ANTHONY JOSEPH DECOSTA D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	38MC00176200	NJ

General Provider Information

NPI Number	:	1124034145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY JOSEPH DECOSTA D.C.

Provider Business Mailing Address
First Line	:	129 S PLAINFIELD AVE
Second Line	:
City	:	SOUTH PLAINFIELD
State	:	NJ
Zip	:	07080-4034
Country	:	US
Telephone Number	:	908-755-1117
Fax Number	:	908-755-8273

Provider Business Practice Location Address
First Line	:	129 S PLAINFIELD AVE
Second Line	:
City	:	SOUTH PLAINFIELD
State	:	NJ
Zip	:	07080-4048
Country	:	US
Telephone Number	:	908-755-1117
Fax Number	:	908-755-8273

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2020

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