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General NPI Number Information
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NPI Number | 1972185296
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Entity Type | Individual
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Provider Name | JOANNA KOSTIN
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Gender | Female
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Dates
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Enumeration Date | 04/26/2021
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Last Update Date | 05/21/2024
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Provider Practice Location Address
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Address Line | 3322 US HIGHWAY 22 STE 1104
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City | BRANCHBURG
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State | NJ
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Zip | 08876-4405
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Country | US
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Telephone | 908-595-1221
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Fax |
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Provider Business Mailing Address
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Address Line | 667 CASE RD
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City | BRANCHBURG
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State | NJ
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Zip | 08853-4171
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Country | US
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Telephone | 732-208-8444
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02870801
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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