Benjamin Robert Kosteva, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

1332 Issued in NH

Practice address

10529 S Riva Ridge Loop
Fort Drum, NY 13602

Phone

(315) 774-8155

NPI assigned

Jun 28, 2017

Last updated

Sep 2, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1498608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662076800000",
    "number": "1558882738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 WOODS POND DR",
            "city": "WESTFORD",
            "state": "MA",
            "postal_code": "01886",
            "telephone_number": "978-654-1296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10529 S RIVA RIDGE LOOP",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "13602",
            "telephone_number": "315-774-8155"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "315 Turnpike St",
            "address_purpose": "LOCATION",
            "city": "North Andover",
            "state": "MA",
            "postal_code": "018455806",
            "country_code": "US",
            "telephone_number": "978-837-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOSTEVA",
        "first_name": "BENJAMIN",
        "middle_name": "ROBERT",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-28",
        "last_updated": "2022-09-02",
        "certification_date": "2022-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MA",
            "license": "S04697720",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NH",
            "license": "1332",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ian Kinkel, DPT
• Morgan Rae Kitto, LCSW
• Kyle Jay Klahs, DO
• Tess Klossner, LAT, ATC
• Andrew Jerome Kosmowski, MD
• Elizabeth Kramer
• Mark James Kriezis, MSW
• Stephen Gerald Kulka, DMD
• Sabrina Emerald Kunciw, M.D.
• Mitchell Garrett Lamb, DMD

• Athletic Trainer in Fort Drum, NY
• Providers in Fort Drum, NY by specialty
• Athletic Trainer in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 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.

Verify at the official NPI Registry.