Provider Demographics
NPI:1225038375
Name:GULMATICO, CONSTANTINO VALDERRAMA JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CONSTANTINO
Middle Name:VALDERRAMA
Last Name:GULMATICO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-5317
Mailing Address - Country:US
Mailing Address - Phone:718-258-4848
Mailing Address - Fax:718-258-4851
Practice Address - Street 1:1430 E 29TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-5317
Practice Address - Country:US
Practice Address - Phone:718-258-4848
Practice Address - Fax:718-258-4851
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149265208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00978890Medicaid
NY00978890Medicaid
NY81D061Medicare ID - Type Unspecified