| Theodore A. Dacosta Md Pa | |
|
22 Chestnut St Livingston NJ 07039-5502 | |
| (973) 422-0094 | |
| (973) 422-9895 |
| Full Name | Theodore A. Dacosta Md Pa |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 22 Chestnut St, Livingston, New Jersey |
| Authorized Official Name and Position | Theodore Anthony Dacosta (PRESIDENT) |
| Authorized Official Contact | 9734220094 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Theodore A. Dacosta Md Pa 22 Chestnut St Livingston NJ 07039-5502 Ph: (973) 422-0094 | Theodore A. Dacosta Md Pa 22 Chestnut St Livingston NJ 07039-5502 Ph: (973) 422-0094 |
| NPI Number | 1295978385 |
|---|---|
| Provider Enumeration Date | 04/20/2009 |
| Last Update Date | 04/20/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295978385 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | MA56002 (New Jersey) | Primary |
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