Provider Demographics
NPI:1316009467
Name:COSTER, LISHA JEAN (CNM)
Entity Type:Individual
Prefix:
First Name:LISHA
Middle Name:JEAN
Last Name:COSTER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 MAIN ST
Mailing Address - Street 2:OPEN DOOR FAMILY MEDICAL CENTERS, INC.
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-4702
Mailing Address - Country:US
Mailing Address - Phone:914-941-1263
Mailing Address - Fax:914-941-0993
Practice Address - Street 1:165 MAIN ST
Practice Address - Street 2:OPEN DOOR FAMILY MEDICAL CENTERS, INC.
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-4702
Practice Address - Country:US
Practice Address - Phone:914-941-1263
Practice Address - Fax:914-941-0993
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000153-1367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01420328Medicaid