Dacosta, Theodore R

Dacosta, Theodore R is an individual health care provider with primary practice located at 59 Main St Ste 1 , West Orange NJ 07052-5341. He recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Gastroenterology. Allopathic & Osteopathic Physicians / Gastroenterology is his primary health care specialty. Dacosta, Theodore R can be contacted via phone (973) 674-8866.

Contact Information

Primary practice address
59 Main St Ste 1 West Orange NJ 07052-5341
Phone: (973) 674-8866
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X New Jersey
Allopathic & Osteopathic Physicians / Gastroenterology 207RG0100X 25MB12193600 New Jersey

Profile Details

NPI number 1114420155
LBN Legal business name Dacosta, Theodore R
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 15th, 2018
Last updated May 30th, 2024 - about 6 months 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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