Provider Demographics
NPI:1295713097
Name:RIZZUTO - COSTA, MARGARET CECELIA (PMHNP)
Entity type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:CECELIA
Last Name:RIZZUTO - COSTA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:MS
Other - First Name:MARGARET
Other - Middle Name:CECELIA
Other - Last Name:RIZZUTO COSTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:42 SEAMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3129
Mailing Address - Country:US
Mailing Address - Phone:516-764-5401
Mailing Address - Fax:
Practice Address - Street 1:42 SEAMAN AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3129
Practice Address - Country:US
Practice Address - Phone:516-764-5401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400564363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02474344Medicaid