Individual
NOSHIR A DACOSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
48 ROUTE 25A STE 209, SMITHTOWN, NY 11787-1449
(631) 751-3000
(631) 509-6559
Mailing address
1500 ROUTE 112 BLDG 4, PORT JEFFERSON STATION, NY 11776-8055
(631) 751-0000
(631) 509-6559
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
194187
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01813125
—
NY
Enumeration date
01/12/2006
Last updated
01/17/2020
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