Basic Information
| Provider Information | |||||||||
| NPI: | 1306169537 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COSTA | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.P.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 MAMARONECK AVE | ||||||||
| Address2: | |||||||||
| City: | HARRISON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105281635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147238100 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 600 MAMARONECK AVE | ||||||||
| Address2: | |||||||||
| City: | HARRISON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105281635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147238100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2010 | ||||||||
| LastUpdateDate: | 04/06/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 04/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 006352 | NY | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213ES0103X | 006352 | NY | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.