=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497562177
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COSTA ORTHOPEDICS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2024
-----------------------------------------------------
Last Update Date | 12/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 135 RT 35 SUITE 7
-----------------------------------------------------
City | EATONTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-440-7322
-----------------------------------------------------
Fax | 732-217-2483
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 135 RT 35 SUITE 7
-----------------------------------------------------
City | EATONTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-440-7322
-----------------------------------------------------
Fax | 732-217-2483
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ANTHONY JOSEPH COSTA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 732-440-7322
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------