MEDICARE: MS. ROSE COSTANZO MA CCC-SLP, TSSLD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1437658481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROSE COSTANZO MA CCC-SLP, TSSLD

Provider Business Mailing Address
First Line	:	240 E SHORE RD APT 415
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11023-2446
Country	:	US
Telephone Number	:	516-426-8524
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 E SHORE RD APT 415
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11023-2446
Country	:	US
Telephone Number	:	516-426-8524
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2018
Last Update Date	:	02/05/2018

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Directions to “ MS. ROSE COSTANZO MA CCC-SLP, TSSLD” Practice Location

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