Provider Demographics
NPI:1609153154
Name:CONSTANTINO, PATRICK SUCLAD (PT)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:SUCLAD
Last Name:CONSTANTINO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 CUSTER AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-1705
Mailing Address - Country:US
Mailing Address - Phone:201-888-1865
Mailing Address - Fax:
Practice Address - Street 1:133 E 58TH ST
Practice Address - Street 2:SUITE 708
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1236
Practice Address - Country:US
Practice Address - Phone:212-371-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030767225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist