Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Nicholas Michael Kostishak Jr., PA-C, ATC

Individual provider Athletic Trainer · NPI 1487085676

Mr. Nicholas Michael Kostishak Jr., PA-C, ATC is an Athletic Trainer in New York, New York. Practices as a sole proprietor and works from 2 locations. Licensed in Arizona and New York.

Licensed in
AZ, NY
In the registry since
2013
Specialties on file
3
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.
ATC — Certified Athletic Trainer
Prevents and treats sport and activity injuries.

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Practice location Address checks out

1000 10th Ave # 2A05
New York, NY 10019-1147
Phone: (516) 375-6459
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 3469 Stephen Ln, Wantagh, NY 11793-3105 — (516) 375-6459

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 024450 (NY)
Athletic Trainer Taxonomy 2255A2300X · Licence 002702 (NY)
Athletic Trainer Taxonomy 2255A2300X · Licence 1134 (AZ)

Record details

NPI number1487085676
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C , ATC
Sole proprietorYes
NPI enumeratedDecember 12, 2013
Last updated in NPPESJanuary 30, 2023
Certification dateJanuary 30, 2023

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