Provider Demographics
NPI:1669441499
Name:COSTABILE, DAVID J (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:COSTABILE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:12 TAPPAN TER
Mailing Address - Street 2:
Mailing Address - City:BRIARCLIFF MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10510-1350
Mailing Address - Country:US
Mailing Address - Phone:914-366-0015
Mailing Address - Fax:914-366-0012
Practice Address - Street 1:22 SAW MILL RIVER RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-1533
Practice Address - Country:US
Practice Address - Phone:914-366-0015
Practice Address - Fax:914-366-0012
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2013-07-23
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Provider Licenses
StateLicense IDTaxonomies
NY2215482080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02543460Medicaid
NY02543460Medicaid
NY5B4731Medicare ID - Type Unspecified