Basic Information
| Provider Information | |||||||||
| NPI: | 1639254634 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COSTA | ||||||||
| FirstName: | GERMAN | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3196 KENNEDY BLVD | ||||||||
| Address2: | MAILBOX 16A | ||||||||
| City: | UNION CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070872436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2017959080 | ||||||||
| FaxNumber: | 2017959434 | ||||||||
| Practice Location | |||||||||
| Address1: | 3196 KENNEDY BLVD | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | UNION CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070872436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2017959080 | ||||||||
| FaxNumber: | 2017959434 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 01/04/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 25MA07273600 | NJ | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 5538H | 01 | EMPIRE | OTHER | 3007104 | 01 | AETNA | OTHER | P3453578 | 01 | OXFORD | OTHER | 6718749 | 01 | CIGNA | OTHER | 9048901 | 05 | NJ | MEDICAID |