Provider Demographics
NPI:1508297730
Name:LACOSTA, ROBERT (BC-HIS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:LACOSTA
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:398 FEURA BUSH RD
Mailing Address - Street 2:
Mailing Address - City:GLENMONT
Mailing Address - State:NY
Mailing Address - Zip Code:12077-2954
Mailing Address - Country:US
Mailing Address - Phone:518-435-1250
Mailing Address - Fax:518-449-3073
Practice Address - Street 1:398 FEURA BUSH RD
Practice Address - Street 2:
Practice Address - City:GLENMONT
Practice Address - State:NY
Practice Address - Zip Code:12077-2954
Practice Address - Country:US
Practice Address - Phone:518-435-1250
Practice Address - Fax:518-449-3073
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-13
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000046643237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist