Organization
THEODORE A. DACOSTA MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THEODORE ANTHONY DACOSTA MD (PRESIDENT)
(973) 422-0094
Entity
Organization
Contact information
Practice address
22 CHESTNUT ST, LIVINGSTON, NJ 07039-5502
(973) 422-0094
(973) 422-9895
Mailing address
22 CHESTNUT ST, LIVINGSTON, NJ 07039-5502
(973) 422-0094
(973) 422-9895
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
MA56002
NJ
Other
Enumeration date
04/20/2009
Last updated
04/20/2009
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