Individual provider Active NPI

Victoria Christina Costales, MD

  • Internal Medicine Physician
  • Teaneck, NJ
National Provider Identifier
1902033236
Registry record updated Dec 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MA12007800 Issued in NJ
Practice address
718 Teaneck Rd
Teaneck, NJ 07666-4245
Phone
(201) 541-5929
Fax
(201) 379-5611
NPI assigned
Jun 12, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 13, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 052259 CT
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 25MA12007800 NJ Primary

Addresses

Primary practice location

718 Teaneck Rd
Teaneck, NJ 07666-4245

Mailing address

3 University PLZ Ste 205
Hackensack, NJ 07601-6208

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240213000578 NJ Practitioner - Internal Medicine 4284858119 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Albert Einstein College of Medicine of Yeshiva University, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Excelcare Medical Associates PAGroup PAC ID 4284647868, 200 clinicians

Practice addresses (Care Compare)

718 Teaneck Rd
Teaneck, NJ 07666-4245
Phone (201) 227-6050

Hospital & facility affiliations

  • Holy Name Medical Center Hospital, Teaneck, NJ, CCN 310008

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
052259CTMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Excelcare Medical Associates, PA Multi-Specialty CurrentSince Feb 1, 2024 Accepting new patients

Locations

3 University Plz
Ste 205
Hackensack, NJ 07601

1 W Ridgewood Ave
Ste 203
Paramus, NJ 07652
Phone (201) 312-5243

718 Teaneck Rd
Teaneck, NJ 07666
Phone (201) 833-3232

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1244764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734048000000",
    "number": "1902033236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 UNIVERSITY PLZ STE 205",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076016208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "718 TEANECK RD",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076664245",
            "telephone_number": "201-541-5929",
            "fax_number": "201-379-5611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTALES",
        "first_name": "VICTORIA",
        "middle_name": "CHRISTINA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-06-12",
        "last_updated": "2024-12-13",
        "certification_date": "2024-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "052259",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA12007800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Teaneck, NJ

Sources for this page

Verify at the official NPI Registry.