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General NPI Number Information
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NPI Number | 1154300622
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Entity Type | Individual
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Provider Name | NOSHIR A DACOSTA MD
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Gender | Male
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Dates
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Enumeration Date | 01/12/2006
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Last Update Date | 01/17/2020
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Provider Practice Location Address
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Address Line | 48 ROUTE 25A STE 209
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City | SMITHTOWN
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State | NY
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Zip | 11787-1449
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Country | US
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Telephone | 631-751-3000
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Fax | 631-509-6559
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Provider Business Mailing Address
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Address Line | 1500 ROUTE 112 BLDG 4
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-8055
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Country | US
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Telephone | 631-751-0000
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Fax | 631-509-6559
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 194187
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License Number State | NY
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