Basic Information
| Provider Information | |||||||||
| NPI: | 1649335316 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COSTA | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | LUIS | ||||||||
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| Credential: | RPA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41 REMSEN CIR | ||||||||
| Address2: | |||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107101006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6464566971 | ||||||||
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| Practice Location | |||||||||
| Address1: | 177 FORT WASHINGTON AVE | ||||||||
| Address2: | MILSTEIN PAVILION, SUITE 7-435, CARDIOTHORACIC SURGERY | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100323733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123058312 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2006 | ||||||||
| LastUpdateDate: | 12/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 0061421 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363AS0400X | 006142 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.