Theodore a. Dacosta MD PA

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

MA56002 Issued in NJ

Legal business name

THEODORE A. DACOSTA MD PA

Practice address

22 Chestnut St
Livingston, NJ 07039-5502

Phone

(973) 422-0094

Fax

(973) 422-9895

NPI assigned

Apr 20, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Theodore Anthony Dacosta, MD

Title

President

Phone

(973) 422-0094

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1240185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240185600000",
    "number": "1295978385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 CHESTNUT ST",
            "city": "LIVINGSTON",
            "state": "NJ",
            "postal_code": "070395502",
            "telephone_number": "973-422-0094",
            "fax_number": "973-422-9895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 CHESTNUT ST",
            "city": "LIVINGSTON",
            "state": "NJ",
            "postal_code": "070395502",
            "telephone_number": "973-422-0094",
            "fax_number": "973-422-9895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEODORE A. DACOSTA MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-20",
        "last_updated": "2009-04-20",
        "status": "A",
        "authorized_official_last_name": "DACOSTA",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "973-422-0094",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NJ",
            "license": "MA56002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.