Dacosta Medical Group Llc

LBN: Dacosta Medical Group Llc
Dacosta Medical Group Llc is an health care organization with primary practice located at 85 S Jefferson Street , Orange NJ 07050. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Gastroenterology, which is considered as the primary health care specialty. Dacosta Medical Group Llc can be contacted via phone (973) 674-8866, or through Dacosta, Theodore 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
Authorized official contact:
Name: Dacosta, Theodore Doctor of Medicine (MD)
Phone: (973) 674-8866

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Gastroenterology 207RG0100X

Profile Details

NPI number 1346461282
LBN Legal business name Dacosta Medical Group Llc
DBA Doing business as
Authorized official Dacosta, Theodore Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date May 1st, 2007
Last updated Apr 23rd, 2010 - about 16 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1346461282 NPPES
New Jersey MEDICAID 9078908

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