MEDICARE: JORGE LUCAS P CONSTANTINO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	176852	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	060067417	OTHER	NY	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598759011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE LUCAS P CONSTANTINO MD

Provider Business Mailing Address
First Line	:	7 SOUTHWOODS BLVD
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12211-2526
Country	:	US
Telephone Number	:	518-292-6000
Fax Number	:	518-292-6050

Provider Business Practice Location Address
First Line	:	2231 BURDETT AVE
Second Line	:	STE 160
City	:	TROY
State	:	NY
Zip	:	12180-2447
Country	:	US
Telephone Number	:	518-292-6200
Fax Number	:	518-292-6228

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	01/30/2015

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Directions to “ JORGE LUCAS P CONSTANTINO MD” Practice Location

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