Healthcare Provider Details

I. General information

NPI: 1184673055
Provider Name (Legal Business Name): ALISON J. COSTALOS I NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISON J COSTALOS I NP

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 09/28/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SOUTH ORANGE AVE
SOUTH ORANGE NJ
07079
US

IV. Provider business mailing address

25 HOLLY ST
CRANFORD NJ
07016
US

V. Phone/Fax

Practice location:
  • Phone: 973-761-9175
  • Fax:
Mailing address:
  • Phone: 908-447-4481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberF430168-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: