Provider Demographics
NPI:1942333703
Name:RICHARD EDWARD CONSTABLE MD PC
Entity Type:Organization
Organization Name:RICHARD EDWARD CONSTABLE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:CONSTABLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-634-4440
Mailing Address - Street 1:655 AMBOY AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-3159
Mailing Address - Country:US
Mailing Address - Phone:732-634-4440
Mailing Address - Fax:732-634-0069
Practice Address - Street 1:655 AMBOY AVE
Practice Address - Street 2:SUITE C
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-3159
Practice Address - Country:US
Practice Address - Phone:732-634-4440
Practice Address - Fax:732-634-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ376392086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ035144Medicare ID - Type Unspecified