Provider Demographics
NPI:1336398700
Name:COSTANTINO, MARIO FERNANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:FERNANDO
Last Name:COSTANTINO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:80 E JERICHO TPKE
Mailing Address - Street 2:100
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3140
Mailing Address - Country:US
Mailing Address - Phone:516-877-2626
Mailing Address - Fax:516-877-2087
Practice Address - Street 1:233 7TH ST
Practice Address - Street 2:101
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5747
Practice Address - Country:US
Practice Address - Phone:516-742-5344
Practice Address - Fax:516-742-3740
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
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Provider Licenses
StateLicense IDTaxonomies
NY182503207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01462248Medicaid
NY01462248Medicaid