Healthcare Provider Details

I. General information

NPI: 1083903561
Provider Name (Legal Business Name): TINA CONSTANTIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 GREAT NECK RD FL 3
GREAT NECK NY
11021-4315
US

IV. Provider business mailing address

111 BROADWAY FL 2
NEW YORK NY
10006-1995
US

V. Phone/Fax

Practice location:
  • Phone: 516-482-6747
  • Fax: 516-482-4851
Mailing address:
  • Phone: 212-263-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number75433
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: