Provider Demographics
NPI:1003016973
Name:KOSTYUK, NATALYA ST (COTA)
Entity Type:Individual
Prefix:
First Name:NATALYA
Middle Name:ST
Last Name:KOSTYUK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 C WINTHROP RD
Mailing Address - Street 2:
Mailing Address - City:MONROE TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08832
Mailing Address - Country:US
Mailing Address - Phone:212-568-2772
Mailing Address - Fax:
Practice Address - Street 1:79C WINTHROP RD
Practice Address - Street 2:
Practice Address - City:MONROE TWP
Practice Address - State:NJ
Practice Address - Zip Code:08831-6692
Practice Address - Country:US
Practice Address - Phone:212-568-2772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09065400224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant