Individual
MICHAEL J COSTANZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
750 E ADAMS ST, SYRACUSE, NY 13210-2306
(315) 464-1800
(315) 464-6252
Mailing address
750 E ADAMS ST, SYRACUSE, NY 13210-2306
(315) 464-1800
(315) 464-6252
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
232408
NY
2086S0129X
Vascular Surgery Physician
Primary
232408
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02560603
—
NY
01
—
P00201338
RAILROAD MEDICARE
NY
Enumeration date
05/11/2006
Last updated
08/27/2013
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