Provider Demographics
NPI:1790053619
Name:KOSTENKO, TONYA (LMT)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:KOSTENKO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 E 25TH ST
Mailing Address - Street 2:#22
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-3126
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:234 E 25TH ST
Practice Address - Street 2:#22
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-3126
Practice Address - Country:US
Practice Address - Phone:646-209-8088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023651-1172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist