Healthcare Provider Details

I. General information

NPI: 1376592675
Provider Name (Legal Business Name): JOSEPH P. COSTABILE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 ROUTE 70 E
CHERRY HILL NJ
08003-2117
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-428-7700
  • Fax: 856-424-9120
Mailing address:
  • Phone: 856-355-0340
  • Fax: 856-355-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number25MA05499800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: