Provider Demographics
NPI:1467490896
Name:KOSTKO, SEMYON (MD)
Entity Type:Individual
Prefix:
First Name:SEMYON
Middle Name:
Last Name:KOSTKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9701 66TH AVE
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4245
Mailing Address - Country:US
Mailing Address - Phone:718-275-5200
Mailing Address - Fax:
Practice Address - Street 1:9701 66TH AVE
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4245
Practice Address - Country:US
Practice Address - Phone:718-275-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234140-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02621089Medicaid
NY02621089Medicaid
NY02621089Medicaid