MEDICARE: ANITA D'COSTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246Z00000X	Other Specialist/Technologist

General Provider Information

NPI Number	:	1184097743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANITA D'COSTA

Provider Business Mailing Address
First Line	:	11045 QUEENS BLVD APT 518
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-5503
Country	:	US
Telephone Number	:	718-880-2054
Fax Number	:

Provider Business Practice Location Address
First Line	:	11045 QUEENS BLVD APT 518
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-5503
Country	:	US
Telephone Number	:	718-880-2054
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2015
Last Update Date	:	11/04/2015

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Directions to “ ANITA D'COSTA ” Practice Location

Language	Start Address	Practice Location

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