Organization
ANN R COSTELLO MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANN R COSTELLO MD (OWNER)
(607) 273-2811
Entity
Organization
Contact information
Practice address
217 N AURORA ST, ITHACA, NY 14850-4345
(607) 273-2811
(607) 273-1170
Mailing address
217 N AURORA ST, ITHACA, NY 14850-4345
(607) 273-2811
(607) 273-1170
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F338797-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F338797-1
STATE LICENSE
NY
Enumeration date
06/25/2015
Last updated
06/25/2015
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