Individual
MRS. LUISA M COSTELLOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
40-16 ASTORIA BLVD, LONG ISLAND CITY, NY 11103
(718) 937-3836
(718) 937-3836
Mailing address
40-16 ASTORIA BLVD, LONG ISLAND CITY, NY 11103
(718) 937-3836
(718) 937-3836
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
044783
NY
122300000X
Dentist
044783
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01432062
—
NY
Enumeration date
09/29/2006
Last updated
09/22/2014
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