Healthcare Provider Details

I. General information

NPI: 1629048137
Provider Name (Legal Business Name): PETER COSTA D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 LIBERTY SQUARE MALL
STONY POINT NY
10980-2400
US

IV. Provider business mailing address

7 LIBERTY SQUARE MALL
STONY POINT NY
10980-2400
US

V. Phone/Fax

Practice location:
  • Phone: 845-429-0520
  • Fax: 845-429-0603
Mailing address:
  • Phone: 845-429-0520
  • Fax: 845-429-0603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN39101
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: