Individual
MARIYKA KOSTOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
45 READE PL, POUGHKEEPSIE, NY 12601-3947
(845) 483-6217
(845) 483-6108
Mailing address
45 READE PL, POUGHKEEPSIE, NY 12601-3947
(845) 483-6217
(845) 483-6108
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
009321
NY
363AS0400X
Surgical Physician Assistant
Primary
009321
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02642946
—
NY
Enumeration date
06/30/2006
Last updated
01/23/2018
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