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Organization
MOSHOLU MEDICAL GROUP P.C
Active
Organization
MOSHOLU MEDICAL GROUP P.C
Active
Other names
Mosholu Medical Group P.C
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THEODORE COSTA DOCU M.D (OWNER)
(718) 601-0627
Entity
Organization
Contact information
Practice address
5750 MOSHOLU AVE, BRONX, NY 10471-2206
(914) 519-7402
(914) 591-9794
Mailing address
5750 MOSHOLU AVE, BRONX, NY 10471-2206
(914) 519-7402
(914) 591-9794
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
182886
NY
207R00000X
Internal Medicine Physician
245895
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01189151
—
NY
05
—
0244899
—
NY
Enumeration date
10/31/2014
Last updated
07/14/2020
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