Provider Demographics
NPI:1851929079
Name:COSTENBADER, ALLISON (PA-C)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:COSTENBADER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 84TH ST
Mailing Address - Street 2:EAST
Mailing Address - City:SEA ISLE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08243-1122
Mailing Address - Country:US
Mailing Address - Phone:301-957-4174
Mailing Address - Fax:
Practice Address - Street 1:120 84TH ST
Practice Address - Street 2:EAST
Practice Address - City:SEA ISLE CITY
Practice Address - State:NJ
Practice Address - Zip Code:08243-1122
Practice Address - Country:US
Practice Address - Phone:301-957-4174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant