| NPI | 1679955736 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANN R COSTELLO Owner 607-273-2811 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F338797-1) |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2015-06-25 |