MEDICARE: CRAIG COSTA DPM

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	390200000X	Student in an Organized Health Care Education/Training Program
2	213ES0103X	Foot & Ankle Surgery Podiatrist	25MD00331500	NJ

General Provider Information

NPI Number	:	1679990170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG COSTA DPM

Provider Business Mailing Address
First Line	:	100 MORRIS AVE STE 304
Second Line	:
City	:	SPRINGFIELD
State	:	NJ
Zip	:	07081-1427
Country	:	US
Telephone Number	:	973-258-0111
Fax Number	:	973-258-0122

Provider Business Practice Location Address
First Line	:	100 MORRIS AVE STE 304
Second Line	:
City	:	SPRINGFIELD
State	:	NJ
Zip	:	07081-1427
Country	:	US
Telephone Number	:	973-258-0111
Fax Number	:	973-258-0122

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

Provider Enumeration Date	:	03/21/2014
Last Update Date	:	02/06/2017

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Directions to “ CRAIG COSTA DPM” Practice Location

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