NPIMap

Organization Active NPI

Ann R Costello

Doing business as Costello and Costello MDS

  • Non-Pharmacy Dispensing Site
  • Ithaca, NY
National Provider Identifier
1144635087
Registry record updated Jan 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
149866 Issued in NY
Legal business name
ANN R COSTELLO
Doing business as
Costello and Costello MDS
Practice address
217 N Aurora St
Suite 2
Ithaca, NY 14850-4345
Phone
(607) 273-2811
NPI assigned
Jun 30, 2014
Last updated
Jan 13, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
MEDVANTX, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 13, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Scott Peterson
Title
Cfo
Phone
(858) 625-2990

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X 149866 NY Primary

Addresses

Primary practice location

217 N Aurora St
Suite 2
Ithaca, NY 14850-4345

Mailing address

9276 Scranton Rd
Suite 100
San Diego, CA 92121-7701

Other names 1

  • Costello and Costello MDS Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ann R Costello MD3 organizations share this tax ID, including this one
Part of
Medvantx Inc

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1404086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484265600000",
    "number": "1144635087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9276 SCRANTON RD",
            "address_2": "SUITE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921217701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 N AURORA ST",
            "address_2": "SUITE 2",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148504345",
            "telephone_number": "607-273-2811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANN R COSTELLO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2014-06-30",
        "last_updated": "2017-01-13",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NY",
            "license": "149866",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Costello and Costello MDS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ithaca, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.