Basic Information
| Provider Information | |||||||||
| NPI: | 1790791671 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COSTA | ||||||||
| FirstName: | ANTOINETTE | ||||||||
| MiddleName: | GERALDINE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 181 MCMANE AVE | ||||||||
| Address2: | |||||||||
| City: | BERKELEY HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079222202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9086652087 | ||||||||
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| Practice Location | |||||||||
| Address1: | 385 TREMONT AVE | ||||||||
| Address2: | |||||||||
| City: | EAST ORANGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070181023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9736761000 | ||||||||
| FaxNumber: | 9733957010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | 25 MA 04272000 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
No ID Information.