Individual
DR. ELIZABETH M COSTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
360 WASHINGTON AVE, KINGSTON, NY 12401-3702
(845) 338-7140
(845) 338-7141
Mailing address
360 WASHINGTON AVE, KINGSTON, NY 12401-3702
(845) 338-7140
(845) 338-7141
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
208510-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02099250
—
NY
01
—
080167991
RAILROAD MEDICARE
—
01
—
10053448
CDPHP
NY
01
—
228061
WELLCARE
—
01
—
69115
GHI HMO
—
01
—
855858
MVP
NY
01
—
EM032V1510
EMPIRE BLUE CROSS
—
Enumeration date
06/08/2005
Last updated
10/07/2015
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