MEDICARE: DR. PETER COSTA D.P.M.

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	213ES0131X	Foot Surgery Podiatrist	N39101	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	P41041	OTHER	NY	EMPIRE BCBS

General Provider Information

NPI Number	:	1629048137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER COSTA D.P.M.

Provider Business Mailing Address
First Line	:	7 LIBERTY SQUARE MALL
Second Line	:
City	:	STONY POINT
State	:	NY
Zip	:	10980-2400
Country	:	US
Telephone Number	:	845-429-0520
Fax Number	:	845-429-0603

Provider Business Practice Location Address
First Line	:	7 LIBERTY SQUARE MALL
Second Line	:
City	:	STONY POINT
State	:	NY
Zip	:	10980-2400
Country	:	US
Telephone Number	:	845-429-0520
Fax Number	:	845-429-0603

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	03/27/2024

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