Provider Demographics
NPI:1548443278
Name:PETER COSTA, D.P.M.
Entity type:Organization
Organization Name:PETER COSTA, D.P.M.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TORREGROSSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-429-0520
Mailing Address - Street 1:7 LIBERTY SQUARE MALL
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980-2400
Mailing Address - Country:US
Mailing Address - Phone:845-429-0520
Mailing Address - Fax:845-429-0603
Practice Address - Street 1:7 LIBERTY SQUARE MALL
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NY
Practice Address - Zip Code:10980-2400
Practice Address - Country:US
Practice Address - Phone:845-429-0520
Practice Address - Fax:845-429-0603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN39101213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00901804Medicaid
NYP41041Medicare PIN
NYT51268Medicare UPIN
NY5159750001Medicare NSC