Individual
BRYAN PATRICK COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, ATC
Contact information
Practice address
140 E 14TH ST, NEW YORK, NY 10003-4170
(212) 998-2073
Mailing address
140 E 14TH ST, NEW YORK, NY 10003-4170
(212) 998-2073
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
003236
NY
Other
Enumeration date
12/15/2016
Last updated
12/15/2016
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