Healthcare Provider Details

I. General information

NPI: 1356303390
Provider Name (Legal Business Name): CONSTANTINE ROSSAKIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 09/24/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 EAST SPRING VALLEY AVENUE SUTIE #100
MAYWOOD NJ
07607-2154
US

IV. Provider business mailing address

25 EAST SPRING VALLEY AVENUE SUTIE #100
MAYWOOD NJ
07607-2154
US

V. Phone/Fax

Practice location:
  • Phone: 201-489-3440
  • Fax: 201-712-1222
Mailing address:
  • Phone: 201-489-3440
  • Fax: 201-712-1222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMA053041
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: