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General NPI Number Information
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NPI Number | 1942333703
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Entity Type | Organization
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Legal Business Name | RICHARD EDWARD CONSTABLE MD PC
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 655 AMBOY AVE SUITE C
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City | WOODBRIDGE
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State | NJ
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Zip | 07095-3159
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Country | US
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Telephone | 732-634-4440
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Fax | 732-634-0069
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Provider Business Mailing Address
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Address Line | 655 AMBOY AVE SUITE C
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City | WOODBRIDGE
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State | NJ
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Zip | 07095-3159
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Country | US
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Telephone | 732-634-4440
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Fax | 732-634-0069
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Authorized Official
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Title or Position | PROPRIETOR
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Name | DR. RICHARD EDWARD CONSTABLE
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Credential | MD
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Telephone | 732-634-4440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number | NJ37639
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License Number State | NJ
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