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General NPI Number Information
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NPI Number | 1568536068
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Entity Type | Individual
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Provider Name | CONSTANTIN ILIESCU M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7019 37TH AVE
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-3922
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Country | US
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Telephone | 718-457-7955
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Fax | 718-457-7891
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Provider Business Mailing Address
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Address Line | 1 CHERRY LN
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City | SCARSDALE
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State | NY
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Zip | 10583-3117
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Country | US
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Telephone | 914-725-2564
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Fax | 914-725-3192
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 119482
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License Number State | NY
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