Provider Demographics
NPI:1285912634
Name:COSTIGAN, NICOLE BETH (RPA-C)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:BETH
Last Name:COSTIGAN
Suffix:
Gender:F
Credentials:RPA-C
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Mailing Address - Street 1:1275 YORK AVE # 124
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6007
Mailing Address - Country:US
Mailing Address - Phone:212-639-5985
Mailing Address - Fax:929-321-7122
Practice Address - Street 1:1275 YORK AVE # MRI1027
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065
Practice Address - Country:US
Practice Address - Phone:212-639-3099
Practice Address - Fax:212-717-3677
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2019-09-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYP81199363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical