MEDICARE: CATHERINE COSTA GARDYN PMHNP-BC, ANP

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	363LA2200X	Adult Health Nurse Practitioner	306698	NY
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	402096	NY

General Provider Information

NPI Number	:	1447615992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE COSTA GARDYN PMHNP-BC, ANP

Provider Business Mailing Address
First Line	:	64 WOODCHUCK HOLLOW RD
Second Line	:
City	:	COLD SPRING HARBOR
State	:	NY
Zip	:	11724-2435
Country	:	US
Telephone Number	:	516-551-7112
Fax Number	:

Provider Business Practice Location Address
First Line	:	64 WOODCHUCK HOLLOW RD
Second Line	:
City	:	COLD SPRING HARBOR
State	:	NY
Zip	:	11724-2435
Country	:	US
Telephone Number	:	516-551-7112
Fax Number	:

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

Provider Enumeration Date	:	12/29/2015
Last Update Date	:	12/31/2025

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