| Robert Costello Md Llc | |
|
220 Hamburg Tpke Suite 8 Wayne NJ 07470-2110 | |
| (973) 942-5230 | |
| (973) 942-6652 |
| Full Name | Robert Costello Md Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 220 Hamburg Tpke, Wayne, New Jersey |
| Authorized Official Name and Position | Robert E Costello (AUTHORIZED REPRESENTATIVE) |
| Authorized Official Contact | 2013908705 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Robert Costello Md Llc 220 Hamburg Tpke Suite 8 Wayne NJ 07470-2110 Ph: (973) 942-5230 | Robert Costello Md Llc 220 Hamburg Tpke Suite 8 Wayne NJ 07470-2110 Ph: (973) 942-5230 |
| NPI Number | 1790154540 |
|---|---|
| Provider Enumeration Date | 09/23/2015 |
| Last Update Date | 09/23/2015 |
| Medicare PECOS PAC ID | 8628378494 |
|---|---|
| Medicare Enrollment ID | O20151130001909 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790154540 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Robert E Costello |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326454638 PECOS PAC ID: 6204136088 Enrollment ID: I20151201000216 |
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