Active NPI
Luisa M Costelloe, DDS
- Dentist
- Long Island City, NY
National Provider Identifier
1912099730
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 044783
- Practice address
- 40-16 Astoria Blvd
Long Island City, NY 11103 - Phone
- (718) 937-3836
- Fax
- (718) 937-3836
- NPI assigned
- Sep 29, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 044783 | PR | |
| Dentist | 122300000X | 044783 | NY | Primary |
Addresses
Primary practice location
40-16 Astoria Blvd
Long Island City, NY 11103
Mailing address
40-16 Astoria Blvd
Long Island City, NY 11103
Phone (718) 937-3836
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01432062 | Medicaid | NY |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 044783 | PR | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1411344000000",
"number": "1912099730",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40-16 ASTORIA BLVD",
"city": "LONG ISLAND CITY",
"state": "NY",
"postal_code": "11103",
"telephone_number": "718-937-3836",
"fax_number": "718-937-3836"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40-16 ASTORIA BLVD",
"city": "LONG ISLAND CITY",
"state": "NY",
"postal_code": "11103",
"telephone_number": "718-937-3836",
"fax_number": "718-937-3836"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COSTELLOE",
"first_name": "LUISA",
"middle_name": "M",
"name_prefix": "Mrs.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-29",
"last_updated": "2014-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PR",
"license": "044783",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "044783",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01432062",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Long Island City, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.