MEDICARE: JOHN G COSTINO DO

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	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician	MB02575800	NJ
2	207Q00000X	Family Medicine Physician	MB02575800	NJ

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

General Provider Information

NPI Number	:	1811978414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN G COSTINO DO

Provider Business Mailing Address
First Line	:	404 SURF AVE
Second Line	:
City	:	NORTH WILDWOOD
State	:	NJ
Zip	:	08260-5865
Country	:	US
Telephone Number	:	609-522-8358
Fax Number	:	609-729-8662

Provider Business Practice Location Address
First Line	:	404 SURF AVE
Second Line	:
City	:	NORTH WILDWOOD
State	:	NJ
Zip	:	08260-5865
Country	:	US
Telephone Number	:	609-522-8358
Fax Number	:	609-729-8662

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

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	07/18/2007

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Directions to “ JOHN G COSTINO DO” Practice Location

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