Jack Emanuel Costas Jr.
Individual provider Active NPI Registered Nurse · Shoreham, NY
NPI 1649840372 · NPPES record last updated Jun 25, 2021
Key facts
- NPI
- 1649840372
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 798819-01 (NY)
- Practice address
- 9 The BND
Shoreham, NY 11786-2239 - Phone
- (516) 787-2405
- NPI assigned
- Jun 25, 2021
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 798819-01 | NY | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 798819-01 | NY | Yes |
Addresses
Primary practice location
9 The BND
Shoreham, NY 11786-2239
Mailing address
9 The BND
Shoreham, NY 11786-2239
Phone (516) 787-2405
Other providers in Shoreham, NY
- Susan Michele Clancy
- Barbara Clasen
- Jordan Alexis Cohen
- Brian Connelly
- Joseph William Connolly
- Kristin Marie Crimi
- Valerie Ellen Daggett
- Kimberly A Daleo
- Kathleen Ann Delaney
- Allison Desmond
All providers in Shoreham, NY · Registered Nurse in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 25, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.