Healthcare Provider Details

I. General information

NPI: 1124124003
Provider Name (Legal Business Name): CONSTANTINE IOANNOU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 05/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 HEMPSTEAD TPKE NASSAU UNIVERSITY MEDICAL CENTER
EAST MEADOW NY
11554-1859
US

IV. Provider business mailing address

70 GLEN ST SUITE 260
GLEN COVE NY
11542-2855
US

V. Phone/Fax

Practice location:
  • Phone: 516-572-6511
  • Fax:
Mailing address:
  • Phone: 516-656-4565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number180863
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: