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General NPI Number Information
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NPI Number | 1013977651
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Entity Type | Individual
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Provider Name | SOPHIA GIGOS-COSTEAS M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/27/2006
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Last Update Date | 11/13/2019
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Provider Practice Location Address
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Address Line | 910 E 172ND ST FL 3
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City | BRONX
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State | NY
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Zip | 10460-5802
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Country | US
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Telephone | 347-767-2200
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Fax | 212-682-2613
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Provider Business Mailing Address
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Address Line | 1140 BLOOMFIELD AVE SUITE 213
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City | WEST CALDWELL
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State | NJ
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Zip | 07006-7130
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Country | US
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Telephone | 973-228-6302
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Fax | 973-228-6305
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | MA65126
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 200486
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License Number State | NY
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