Provider Demographics
NPI:1972863728
Name:KONSTANCE, EMMANUEL ESPER (MD)
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:ESPER
Last Name:KONSTANCE
Suffix:
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 1:49 WEST 87TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3028
Mailing Address - Country:US
Mailing Address - Phone:212-496-0833
Mailing Address - Fax:954-568-5740
Practice Address - Street 1:49 WEST 87TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3028
Practice Address - Country:US
Practice Address - Phone:212-496-0833
Practice Address - Fax:954-568-5740
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY083056-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBO296Medicare UPIN