Provider Demographics
NPI:1205080413
Name:COSTA, JENNIFER L (AUD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:COSTA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:BORKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:660 WHITE PLAINS RD FL 4
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5187
Mailing Address - Country:US
Mailing Address - Phone:914-984-2552
Mailing Address - Fax:
Practice Address - Street 1:1500 NY-112
Practice Address - Street 2:BUILDING 4, 2ND FLOOR
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776
Practice Address - Country:US
Practice Address - Phone:631-928-0188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2240231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist