Provider Demographics
NPI:1053753632
Name:DA COSTA, GLENYS
Entity type:Individual
Prefix:
First Name:GLENYS
Middle Name:
Last Name:DA COSTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 E 81ST ST
Mailing Address - Street 2:APARTMENT 5A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-7026
Mailing Address - Country:US
Mailing Address - Phone:917-657-4813
Mailing Address - Fax:
Practice Address - Street 1:504 E 81ST ST
Practice Address - Street 2:APARTMENT 5A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-7026
Practice Address - Country:US
Practice Address - Phone:917-657-4813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program