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	207QS0010X	Sports Medicine (Family 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	:	1851355374
Entity Type Code	:	Organization
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	:

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	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN G COSTINO
Credential	:	DO
Telephone Number	:	609-522-8358

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	01/31/2008

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