Healthcare Provider Details

I. General information

NPI: 1700792272
Provider Name (Legal Business Name): RACHEL COSTELLO MSN, APN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 CANNON RD
FREEHOLD NJ
07728-1403
US

IV. Provider business mailing address

87 CANNON RD
FREEHOLD NJ
07728-1403
US

V. Phone/Fax

Practice location:
  • Phone: 732-579-7301
  • Fax:
Mailing address:
  • Phone: 732-579-7301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15639000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: