1336266972 NPI number — DAN COSTIN MD PLLC

Table of content: (NPI 1336266972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336266972 NPI number — DAN COSTIN MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAN COSTIN MD PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336266972
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 LONGVIEW AVE
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
WHITE PLAINS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10601-5002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-684-2779
Provider Business Mailing Address Fax Number:
914-684-6859

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 LONGVIEW AVE
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
WHITE PLAINS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10601-5002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-684-2779
Provider Business Practice Location Address Fax Number:
914-684-6859
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NELSON
Authorized Official First Name:
BENEDEK
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
914-684-2779

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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