Provider Demographics
NPI:1558372904
Name:COSTANTINO, PETER DAVID (MD)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:DAVID
Last Name:COSTANTINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4 WESTCHESTER PARK DR
Mailing Address - Street 2:STE 320
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-3497
Mailing Address - Country:US
Mailing Address - Phone:212-434-4500
Mailing Address - Fax:212-434-4580
Practice Address - Street 1:130 EAST 77TH STREET
Practice Address - Street 2:10TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075
Practice Address - Country:US
Practice Address - Phone:212-434-4500
Practice Address - Fax:212-434-4580
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY204458-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY17K791OtherEMPIRE BLUE CROSS
NYP467763OtherOXFORD ID#
NY4C4124OtherHEALTHNET ID#
NY5858397OtherAETNA PPO/POS
NY01704250Medicaid
NY0596816OtherAETNA MANAGED CARE
NYP467763OtherOXFORD ID#
NYF95464Medicare UPIN