Provider Demographics
NPI:1881021723
Name:COSTELLO, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:COSTELLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-5002
Mailing Address - Country:US
Mailing Address - Phone:518-583-7044
Mailing Address - Fax:888-371-1793
Practice Address - Street 1:110 ADAMS ST
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-5002
Practice Address - Country:US
Practice Address - Phone:518-583-7044
Practice Address - Fax:888-371-1793
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies