Provider Demographics
NPI:1861941320
Name:JODY KONSTADT DERMATOLOGY PLLC
Entity type:Organization
Organization Name:JODY KONSTADT DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:KONSTADT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-725-3700
Mailing Address - Street 1:30 CENTRAL PARK S
Mailing Address - Street 2:SUITE 10A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1628
Mailing Address - Country:US
Mailing Address - Phone:914-725-3700
Mailing Address - Fax:914-725-3885
Practice Address - Street 1:700 WHITE PLAINS RD
Practice Address - Street 2:SUITE 30
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5063
Practice Address - Country:US
Practice Address - Phone:914-725-3700
Practice Address - Fax:914-725-3885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty