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Individual
MR. NICHOLAS MICHAEL KOSTISHAK JR.
Active
Individual
MR. NICHOLAS MICHAEL KOSTISHAK JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C, ATC
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
002702
NY
2255A2300X
Athletic Trainer
1134
AZ
363A00000X
Physician Assistant
Primary
024450
NY
Other
Enumeration date
12/12/2013
Last updated
01/30/2023
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