Individual
THEODORE R DACOSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
59 MAIN ST STE 1, WEST ORANGE, NJ 07052-5341
(973) 674-8866
Mailing address
26 MCCHESNEY CT, WEST ORANGE, NJ 07052-1135
(973) 699-3950
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
25MB12193600
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
NJ
Other
Enumeration date
03/15/2018
Last updated
05/30/2024
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