Individual
DR. THEODORE A DACOSTA JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
85 S JEFFERSON STREET, ORANGE, NJ 07050
(973) 674-8866
(973) 672-9299
Mailing address
85 S JEFFERSON STREET, ORANGE, NJ 07050
(973) 674-8866
(973) 672-9299
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
25MA05600200
NJ
207RG0100X
Gastroenterology Physician
Primary
25MA05600200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6881106
—
NJ
Enumeration date
07/11/2006
Last updated
09/11/2025
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