Provider Demographics
NPI:1629154091
Name:COSTANZA, MARK ---
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:---
Last Name:COSTANZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1900 RIDGE RD
Mailing Address - Street 2:HEALTHWORKS-WNY, LLP
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3332
Mailing Address - Country:US
Mailing Address - Phone:716-712-0670
Mailing Address - Fax:716-712-0674
Practice Address - Street 1:1900 RIDGE RD
Practice Address - Street 2:HEALTHWORKS-WNY, LLP
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3332
Practice Address - Country:US
Practice Address - Phone:716-712-0670
Practice Address - Fax:716-712-0674
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1680312083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine