Provider Demographics
NPI:1871558437
Name:CONSTANTATOS, CONSTANTINOS (MD)
Entity type:Individual
Prefix:DR
First Name:CONSTANTINOS
Middle Name:
Last Name:CONSTANTATOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 LITTLE EAST NECK RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-7742
Mailing Address - Country:US
Mailing Address - Phone:631-321-4147
Mailing Address - Fax:
Practice Address - Street 1:170 LITTLE EAST NECK RD
Practice Address - Street 2:SUITE 1
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-7742
Practice Address - Country:US
Practice Address - Phone:631-321-4147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221733208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02172241Medicaid
NY02172241Medicaid
NY523Y41Medicare PIN