Provider Demographics
NPI:1093810368
Name:COSTANZO, JOSEPH V (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:V
Last Name:COSTANZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:292 LONG RIDGE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-1627
Mailing Address - Country:US
Mailing Address - Phone:203-348-9455
Mailing Address - Fax:203-348-9183
Practice Address - Street 1:292 LONG RIDGE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-1627
Practice Address - Country:US
Practice Address - Phone:203-348-9455
Practice Address - Fax:203-348-9183
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT030781207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine