NICHOLAS MICHAEL KOSTISHAK

NEW YORK, NY
NPI1487085676
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy363A00000X Physician Assistant
(Licence: NY  024450)
Additional Taxonomies2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: NY  002702)
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: AZ  1134)
Enumeration Date2013-12-12
Last Update Date2023-01-30
Business Address
Mr. NICHOLAS MICHAEL KOSTISHAK PA-C, ATC
1000 10TH AVE # 2A05
NEW YORK, NY 10019-1147
Phone number: 516-375-6459
Mailing Address
Mr. NICHOLAS MICHAEL KOSTISHAK PA-C, ATC
3469 STEPHEN LN
WANTAGH, NY 11793-3105
Phone number: 516-375-6459