MEDICARE: ANTHONY SALVATORE COSTANZO PT, DPT

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	225100000X	Physical Therapist	40QA01990600	NJ

General Provider Information

NPI Number	:	1285226795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY SALVATORE COSTANZO PT, DPT

Provider Business Mailing Address
First Line	:	900 ROUTE 9 N STE 410
Second Line	:
City	:	WOODBRIDGE
State	:	NJ
Zip	:	07095-1003
Country	:	US
Telephone Number	:	201-801-7141
Fax Number	:

Provider Business Practice Location Address
First Line	:	147 N KINDERKAMACK RD
Second Line	:
City	:	MONTVALE
State	:	NJ
Zip	:	07645-1313
Country	:	US
Telephone Number	:	201-573-4088
Fax Number	:

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

Provider Enumeration Date	:	02/05/2021
Last Update Date	:	02/05/2021

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