THEODORE R DACOSTA

WEST ORANGE, NJ
NPI1114420155
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207RG0100X Internal Medicine, Gastroenterology
(Licence: NJ  25MB12193600)
Additional Taxonomies390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2018-03-15
Last Update Date2024-05-30
Business Address
THEODORE R DACOSTA DO
59 MAIN ST STE 1
WEST ORANGE, NJ 07052-5341
Phone number: 973-674-8866
Mailing Address
THEODORE R DACOSTA DO
26 MCCHESNEY CT
WEST ORANGE, NJ 07052-1135
Phone number: 973-699-3950