Dacosta, Theodore A

Dacosta, Theodore A is an individual health care provider with primary practice located at 85 S Jefferson Street , Orange NJ 07050. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Gastroenterology. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Dacosta, Theodore A can be contacted via phone (973) 674-8866.

Contact Information

Primary practice address
85 S Jefferson Street Orange NJ 07050
Phone: (973) 674-8866
Fax: (973) 672-9299
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 25MA05600200 New Jersey
Allopathic & Osteopathic Physicians / Gastroenterology 207RG0100X 25MA05600200 New Jersey

Profile Details

NPI number 1558395673
LBN Legal business name Dacosta, Theodore A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 11th, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1558395673 NPPES
New Jersey MEDICAID 6881106

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