Individual
DR. CARL COSTANZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
187 CHESTNUT ST, NUTLEY, NJ 07110-2311
(973) 667-4402
(973) 667-6974
Mailing address
PO BOX 1939, BLOOMFIELD, NJ 07003-1939
(973) 743-2331
(973) 743-1441
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MA059660
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0814788000
AMERIHEALTH
NJ
05
—
6583709
—
NJ
Enumeration date
06/29/2006
Last updated
09/09/2009
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