Provider Demographics
NPI:1548438039
Name:EDWIN CONSTANTINO MD LLC
Entity type:Organization
Organization Name:EDWIN CONSTANTINO MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONSTANTINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-656-0440
Mailing Address - Street 1:10 HURON AVE APT 1L
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3627
Mailing Address - Country:US
Mailing Address - Phone:201-656-0440
Mailing Address - Fax:201-656-3444
Practice Address - Street 1:10 HURON AVE APT 1L
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3627
Practice Address - Country:US
Practice Address - Phone:201-656-0440
Practice Address - Fax:201-656-3444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05482600208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ076964Medicare PIN