Provider Demographics
NPI:1023224870
Name:COSTAKIS, ANNA K (MD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:K
Last Name:COSTAKIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7559 263RD ST # 200
Mailing Address - Street 2:
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1150
Mailing Address - Country:US
Mailing Address - Phone:718-470-8080
Mailing Address - Fax:718-831-0368
Practice Address - Street 1:7559 263RD ST # 200
Practice Address - Street 2:
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004
Practice Address - Country:US
Practice Address - Phone:718-470-8080
Practice Address - Fax:718-831-0368
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361191222084P0800X
NY2675752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry