Individual provider · NPI-1

Samantha Leigh Costanzo, PA-C

Physician Assistant · Wall Township, NJ

NPI number1053152298
StatusActive
Last updated in NPPESAug 26, 2024

Details

NPI
1053152298
Entity type
Individual (NPI-1)
Name
Samantha Leigh Costanzo
Credential
PA-C
Sex
Female
Sole proprietor
No
Enumeration date
Jun 3, 2024
Certification date
Aug 26, 2024
Last updated
Aug 26, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363A00000X Physician Assistant25MP00855900NJYes

Practice location

4810 Belmar Blvd
Wall Township, NJ 07753-6952

Phone 732-938-6090 · Fax 732-938-5680

Mailing address

4810 Belmar Blvd
Wall Township, NJ 07753-6952

Phone 732-938-6090 · Fax 732-938-5680

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