Provider Demographics
NPI:1104240977
Name:CINQUEMANI COSTA, KAREN (DPT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:CINQUEMANI COSTA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:CINQUEMANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2460 VICTORY BLVD.
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314
Mailing Address - Country:US
Mailing Address - Phone:718-981-3575
Mailing Address - Fax:718-981-3574
Practice Address - Street 1:2460 VICTORY BLVD.
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314
Practice Address - Country:US
Practice Address - Phone:718-981-3575
Practice Address - Fax:718-981-3574
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037327-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist