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General NPI Number Information
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NPI Number | 1710116488
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Entity Type | Individual
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Provider Name | MARY CONSTANTINO NP
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Gender | Female
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Dates
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Enumeration Date | 07/02/2009
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Last Update Date | 07/02/2009
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Provider Practice Location Address
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Address Line | 99 E STATE ST
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City | GLOVERSVILLE
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State | NY
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Zip | 12078-1203
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Country | US
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Telephone | 518-773-5780
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Fax |
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Provider Business Mailing Address
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Address Line | 454 MAPLE AVE
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City | SARATOGA SPRINGS
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State | NY
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Zip | 12866-5532
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Country | US
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Telephone | 518-587-1141
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Fax | 518-587-1152
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | F335787
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License Number State | NY
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