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Organization
THEODORE C.DOCU MD, PC
Active
Organization
THEODORE C.DOCU MD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THEODORE COSTA DOCU M.D (PRESIDENT)
(212) 568-0553
Entity
Organization
Contact information
Practice address
506 FORT WASHINGTON AVE 1F, 1F, NEW YORK,NY, NY 10033
(212) 568-0553
Mailing address
506 FORT WASHINGTON AVE 1F, 1F, NEW YORK,NY, NY 10033
(212) 568-0553
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
182886
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01189151
—
NY
Enumeration date
04/17/2007
Last updated
08/22/2020
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