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Individual

DR. LOUIS J COSTELLO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DC

Contact information

Practice address
325 USHERS RD, BALLSTON LAKE, NY 12019-1520
(518) 877-0234
Mailing address
325 USHERS RD, BALLSTON LAKE, NY 12019-1520
(518) 877-0234

Taxonomy

Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
X005314
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
F10034971
CDPHP
NY
Enumeration date
11/08/2006
Last updated
07/08/2007
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