Individual
CHARLENE KOSTUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
111 E 210TH ST, MMC -CT SURGERY MAP 5, BRONX, NY 10467-2401
(718) 920-8958
(718) 653-2237
Mailing address
111 E 210TH ST, MAP 5A, BRONX, NY 10467-2401
(718) 920-8958
(718) 653-2237
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001110
NY
Other
Enumeration date
02/22/2008
Last updated
04/29/2008
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