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General NPI Number Information
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NPI Number | 1811367402
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Entity Type | Organization
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Legal Business Name | THOMAS E. COSTELLO, MD, PT, PLLC
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Dates
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Enumeration Date | 09/25/2015
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Last Update Date | 03/14/2023
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Provider Practice Location Address
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Address Line | 14 VILLANOVA LN
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City | DIX HILLS
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State | NY
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Zip | 11746-4841
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Country | US
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Telephone | 516-658-2807
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 464
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City | HUNTINGTON STATION
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State | NY
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Zip | 11746-0374
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | THOMAS E COSTELLO
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Credential | MD
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Telephone | 516-658-2807
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 011915
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 267336
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License Number State | NY
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