Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 25MA08477200 | NJ |
N | 111NI0900X | Internist | 25MA08477200 | NJ |
Y | 207RG0100X | Gastroenterologist | 25MA08477200 | NJ |
NPI | 1043491830 |
---|---|
Provider Name | Dr. Jose C Costa |
First Address | East Brunswick, NJ 08816-3227 |
Second Address | East Brunswick, NJ 08816-7600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2007 |
Last Update Date | 23/09/2015 |