Healthcare Provider Details

I. General information

NPI: 1871558437
Provider Name (Legal Business Name): CONSTANTINOS CONSTANTATOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 LITTLE EAST NECK RD SUITE 1
WEST BABYLON NY
11704-7742
US

IV. Provider business mailing address

170 LITTLE EAST NECK RD SUITE 1
WEST BABYLON NY
11704-7742
US

V. Phone/Fax

Practice location:
  • Phone: 631-321-4147
  • Fax:
Mailing address:
  • Phone: 631-321-4147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number221733
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: