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NPI Code Detail

MEDICARE: COREY COSTA PA

MEDICARE: COREY COSTA PA
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
1363A00000XPhysician Assistant023377NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1891266102
Entity Type Code : Individual
Provider Name (Legal Business Name) : COREY COSTA PA
Provider Business Mailing Address
First Line : 8911 N CAPITAL OF TEXAS HWY STE 1110
Second Line :
City : AUSTIN
State : TX
Zip : 78759-7203
Country : US
Telephone Number : 877-279-5960
Fax Number :
Provider Business Practice Location Address
First Line : 5775 MAELOU DR
Second Line :
City : HAMBURG
State : NY
Zip : 14075-7419
Country : US
Telephone Number : 716-242-9873
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2018
Last Update Date : 04/06/2026

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Directions to “ COREY COSTA PA” Practice Location

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