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Individual

DR. GREGORY ANTHONY COSTELLO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
700 MOUNTAIN AVE, WYCKOFF, NJ 07481-1047
(201) 848-8005
Mailing address
587 EDER AVE, FRANKLIN LAKES, NJ 07417-3011
(201) 847-2422

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25MA06626300
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7619804
NJ
Enumeration date
10/13/2006
Last updated
12/20/2007
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