Provider Demographics
NPI:1124034145
Name:DECOSTA, ANTHONY JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:DECOSTA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 S PLAINFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-4034
Mailing Address - Country:US
Mailing Address - Phone:908-755-1117
Mailing Address - Fax:908-755-8273
Practice Address - Street 1:129 S PLAINFIELD AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-4048
Practice Address - Country:US
Practice Address - Phone:908-755-1117
Practice Address - Fax:908-755-8273
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00176200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ454370Medicare ID - Type Unspecified
T-45395Medicare UPIN