Provider Demographics
NPI:1295033041
Name:EUGENE N. COSTANTINI, M.D.,P.A.
Entity Type:Organization
Organization Name:EUGENE N. COSTANTINI, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:COSTANTINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-462-4413
Mailing Address - Street 1:1777 S ANDREWS AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2517
Mailing Address - Country:US
Mailing Address - Phone:954-462-4413
Mailing Address - Fax:954-462-5413
Practice Address - Street 1:1777 S ANDREWS AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2517
Practice Address - Country:US
Practice Address - Phone:954-462-4413
Practice Address - Fax:954-462-5413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57582208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063842100Medicaid
FL063842100Medicaid