Provider Demographics
NPI:1396921847
Name:COSTIGAN, WILLIAM JR (LAC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:COSTIGAN
Suffix:JR
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BIRCH RD
Mailing Address - Street 2:
Mailing Address - City:PUTNAM VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10579-1304
Mailing Address - Country:US
Mailing Address - Phone:845-528-1729
Mailing Address - Fax:
Practice Address - Street 1:150 CLEARBROOK RD
Practice Address - Street 2:
Practice Address - City:ELMSFORD
Practice Address - State:NY
Practice Address - Zip Code:10523-1117
Practice Address - Country:US
Practice Address - Phone:914-708-9854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003726171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist