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General NPI Number Information
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NPI Number | 1609153154
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Entity Type | Individual
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Provider Name | PATRICK SUCLAD CONSTANTINO PT
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Gender | Male
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Dates
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Enumeration Date | 11/11/2011
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Last Update Date | 11/11/2011
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Provider Practice Location Address
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Address Line | 133 E 58TH ST SUITE 708
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City | NEW YORK
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State | NY
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Zip | 10022-1236
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Country | US
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Telephone | 212-371-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 260 CUSTER AVE 2ND FLOOR
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City | JERSEY CITY
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State | NJ
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Zip | 07305-1705
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Country | US
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Telephone | 201-888-1865
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Fax |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 030767
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License Number State | NY
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