Provider Demographics
NPI:1699864827
Name:DICOSTANZO, ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:DICOSTANZO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1749
Mailing Address - Country:US
Mailing Address - Phone:516-248-0103
Mailing Address - Fax:516-248-4661
Practice Address - Street 1:350 OLD COUNTRY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1749
Practice Address - Country:US
Practice Address - Phone:516-248-0103
Practice Address - Fax:516-248-4661
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008415111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX4B011Medicare PIN