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General NPI Number Information
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NPI Number | 1821270521
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Entity Type | Organization
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Legal Business Name | JOSEPH J. COSTELLO DPM
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 03/19/2008
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Provider Practice Location Address
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Address Line | 45 N MAIN ST SUITE 1
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City | PITTSTON
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State | PA
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Zip | 18640-1915
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Country | US
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Telephone | 570-654-4641
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Fax | 570-654-4642
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Provider Business Mailing Address
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Address Line | 45 N MAIN ST SUITE 1
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City | PITTSTON
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State | PA
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Zip | 18640-1915
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Country | US
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Telephone | 570-654-4641
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Fax | 570-654-4642
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH COSTELLO
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Credential | DPM
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Telephone | 570-654-4641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | SC-003054-L
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License Number State | PA
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