Provider Demographics
NPI:1184673055
Name:COSTALOS, ALISON J I (NP)
Entity Type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:J
Last Name:COSTALOS
Suffix:I
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:ALISON
Other - Middle Name:J
Other - Last Name:COSTALOS
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:126 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2433
Mailing Address - Country:US
Mailing Address - Phone:908-654-0617
Mailing Address - Fax:
Practice Address - Street 1:1275 YORK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-2742
Practice Address - Country:US
Practice Address - Phone:646-422-4329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF430168-1363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care