Provider Demographics
NPI:1902203318
Name:COSTELLO, MARGARET
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARGARET
Other - Middle Name:
Other - Last Name:BIONDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 PERTH RD
Mailing Address - Street 2:MASSAPEQUA
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5934
Mailing Address - Country:US
Mailing Address - Phone:516-647-4837
Mailing Address - Fax:
Practice Address - Street 1:3 PERTH RD
Practice Address - Street 2:MASSAPEQUA
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5934
Practice Address - Country:US
Practice Address - Phone:516-647-4837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY$$$$$$$$$OtherSPECIALSIT