Gregory Anthony Costello, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

25MA06626300 Issued in NJ

Practice address

700 Mountain Ave
Wyckoff, NJ 07481-1047

Phone

(201) 848-8005

NPI assigned

Oct 13, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198108800000",
    "number": "1154411254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "587 EDER AVE",
            "city": "FRANKLIN LAKES",
            "state": "NJ",
            "postal_code": "074173011",
            "telephone_number": "201-847-2422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 MOUNTAIN AVE",
            "city": "WYCKOFF",
            "state": "NJ",
            "postal_code": "074811047",
            "telephone_number": "201-848-8005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTELLO",
        "first_name": "GREGORY",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2007-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MA06626300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7619804",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cognosis
• Community Distributors, Inc.
• Beth Cooper, DPT
• Rise Jayne Cooper, PT
• Sonata Faith Cooper, M.D.
• Susan Renee Creech, LCSW
• Courtney Nicole Crowley
• Britt Cunningham
• Curalta Medical LLC
• James William Curreri, DMD

• Family Medicine Physician in Wyckoff, NJ
• Providers in Wyckoff, NJ by specialty
• Family Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.