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Individual

COREY COSTA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
5775 MAELOU DR, HAMBURG, NY 14075-7419
(716) 242-9873
Mailing address
8911 N CAPITAL OF TEXAS HWY STE 1110, AUSTIN, TX 78759-7203
(877) 279-5960

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
023377
NY
363A00000X
Physician Assistant
Primary
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
05526238
NY
Enumeration date
12/13/2018
Last updated
04/06/2026
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