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NPI Code Detail

MEDICARE: MARIA E COSTELLO

MEDICARE:   MARIA E COSTELLO
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
1225100000XPhysical Therapist006645NY

General Provider Information

NPI Number : 1669488201
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIA E COSTELLO
Provider Business Mailing Address
First Line : 1212 MOLL ST
Second Line :
City : NORTH TONAWANDA
State : NY
Zip : 14120-2253
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4635 UNION RD
Second Line :
City : CHEEKTOWAGA
State : NY
Zip : 14225-1851
Country : US
Telephone Number : 716-505-5700
Fax Number : 716-633-9351
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2006
Last Update Date : 11/07/2008

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Directions to “ MARIA E COSTELLO ” Practice Location

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