| Doctor Name: | MR. GLENN EDWARD COSTELLO |
| NPI Number: | 1174772339 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CP,LPO |
| License Number: | 45PO00010600 |
| Business Practice Address: | 17 Rini Ct Glen Head, NY - 115452407 |
| Business Phone Number: | 5166719798 |
| Business Fax Number: | 5166718714 |
| Mailing Address: | Po Box 475, GLEN HEAD |
| State: | NY |
| Postal Code: | 115450475 |
| Phone Number: | 5166719798 |
| Fax Number: | 5166718714 |
| NPI Enumeration Date: | 09/11/2008 |
| NPI Last Update Date: | 12/16/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 222Z00000X |
| License Number: | 45PO00010600 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NJ |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Orthotist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A health care professional who is specifically educated and trained to manage comprehensive orthotic patient care, including musculoskeletal and neuromuscular anomalies resulting from injuries or disease processes involving the lower extremity, upper extremity or spinal segment/s and positional deformation of the cranium. Orthotists assess specific patient needs, formulate an appropriate treatment plan, implement the treatment plan and provide follow-up care. |