NPI Code Detail JSON Logo

1902033236 NPI number — VICTORIA CHRISTINA COSTALES MD

NPI Number: 1902033236
Health Care Provider/Practitioner: VICTORIA CHRISTINA COSTALES MD

Information about “1902033236” NPI (VICTORIA CHRISTINA COSTALES MD) exists in 1902033236 in HTML format HTML  |  1902033236 in plain Text format TXT  |  1902033236 in PDF (Portable Document Format) PDF  |  1902033236 in an XML format XML  formats.

NPI Number : 1902033236 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1902033236",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "COSTALES",
    "FirstName": "VICTORIA",
    "MiddleName": "CHRISTINA",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3 UNIVERSITY PLZ STE 205",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HACKENSACK",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "07601-6208",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "718 TEANECK RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TEANECK",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "07666-4245",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "201-541-5929",
    "PracticeLocationAddressFaxNumber": "201-379-5611",
    "EnumerationDate": "06/12/2009",
    "LastUpdateDate": "12/13/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207R00000X",
          "TaxonomyName": "Internal Medicine Physician",
          "LicenseNumber": "052259",
          "LicenseNumberStateCode": "CT",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207R00000X",
          "TaxonomyName": "Internal Medicine Physician",
          "LicenseNumber": "25MA12007800",
          "LicenseNumberStateCode": "NJ",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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