Healthcare Provider Details

I. General information

NPI: 1245306679
Provider Name (Legal Business Name): CHRISTOPHER JAMES COSTANTINI C.PED.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3385 BRIGHTON HENRIETTA TOWN LINE RD THE FOOT PERFORMANCE CENTER
ROCHESTER NY
14623-2813
US

IV. Provider business mailing address

PO BOX 18731
ROCHESTER NY
14618-0731
US

V. Phone/Fax

Practice location:
  • Phone: 585-473-5950
  • Fax: 585-473-9596
Mailing address:
  • Phone: 585-224-8581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: