Healthcare Provider Details

I. General information

NPI: 1013977651
Provider Name (Legal Business Name): SOPHIA GIGOS-COSTEAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 E 172ND ST FL 3
BRONX NY
10460-5802
US

IV. Provider business mailing address

1140 BLOOMFIELD AVE SUITE 213
WEST CALDWELL NJ
07006-7130
US

V. Phone/Fax

Practice location:
  • Phone: 347-767-2200
  • Fax: 212-682-2613
Mailing address:
  • Phone: 973-228-6302
  • Fax: 973-228-6305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200486
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMA65126
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: