Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | MA50327 | NJ |
NPI | 1467690446 |
---|---|
Provider Name | Gerald V Costa |
First Address | Warren, NJ 07059-6792 |
Second Address | Warren, NJ 07059-6792 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2009 |
Last Update Date | 28/01/2009 |