Active NPI
Desarae Costanzo
- Physician Assistant
- Philadelphia, PA
National Provider Identifier
1346995446
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 4170 City Ave
Philadelphia, PA 19131-1610 - Phone
- (215) 871-6100
- NPI assigned
- Feb 16, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
4170 City Ave
Philadelphia, PA 19131-1610
Mailing address
1595 Dreshertown Rd
Dresher, PA 19025-1421
Phone (215) 768-3331
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1644969600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1644969600000",
"number": "1346995446",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1595 DRESHERTOWN RD",
"city": "DRESHER",
"state": "PA",
"postal_code": "190251421",
"telephone_number": "215-768-3331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4170 CITY AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191311610",
"telephone_number": "215-871-6100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COSTANZO",
"first_name": "DESARAE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-02-16",
"last_updated": "2022-02-16",
"certification_date": "2022-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.