Provider Demographics
NPI:1306273065
Name:COSTELLO, EILEEN A (FNP)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:A
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:56 45 MAIN STREET
Mailing Address - Street 2:W-LL300
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5045
Mailing Address - Country:US
Mailing Address - Phone:718-670-2127
Mailing Address - Fax:347-328-9362
Practice Address - Street 1:56 45 MAIN STREET
Practice Address - Street 2:W-LL300
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5045
Practice Address - Country:US
Practice Address - Phone:718-670-1185
Practice Address - Fax:718-670-2312
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-26
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF338319-1363LF0000X
NYF338319363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily