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General NPI Number Information
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NPI Number | 1811978414
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Entity Type | Individual
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Provider Name | JOHN G COSTINO DO
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Gender | Male
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Dates
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Enumeration Date | 11/10/2005
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Last Update Date | 07/18/2007
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Provider Practice Location Address
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Address Line | 404 SURF AVE
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City | NORTH WILDWOOD
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State | NJ
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Zip | 08260-5865
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Country | US
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Telephone | 609-522-8358
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Fax | 609-729-8662
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Provider Business Mailing Address
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Address Line | 404 SURF AVE
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City | NORTH WILDWOOD
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State | NJ
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Zip | 08260-5865
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Country | US
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Telephone | 609-522-8358
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Fax | 609-729-8662
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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 | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | MB02575800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MB02575800
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License Number State | NJ
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