Provider Demographics
NPI:1831352921
Name:COSTELLO, MARGARET (ANP)
Entity type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MOTOR PKWY # C
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-5100
Mailing Address - Country:US
Mailing Address - Phone:631-444-9614
Mailing Address - Fax:
Practice Address - Street 1:200 MOTOR PKWY # C
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-5100
Practice Address - Country:US
Practice Address - Phone:631-444-9614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301009-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health