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General NPI Number Information
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NPI Number | 1730306507
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Entity Type | Individual
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Provider Name | ROBIN S DACOSTA MD
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Gender | Female
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 217 PORTION RD
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City | RONKONKOMA
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State | NY
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Zip | 11779-2341
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Country | US
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Telephone | 631-758-3100
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Fax | 631-758-3168
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Provider Business Mailing Address
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Address Line | 1 RESEARCH RD
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City | RIDGE
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State | NY
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Zip | 11961-2701
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Country | US
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Telephone | 631-758-3100
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Fax | 631-758-3168
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 188230
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License Number State | NY
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