Provider Demographics
NPI:1649682485
Name:OAK NORTH
Entity type:Organization
Organization Name:OAK NORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANTINOS
Authorized Official - Middle Name:
Authorized Official - Last Name:CONSTANTINOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-450-4038
Mailing Address - Street 1:773 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5102
Mailing Address - Country:US
Mailing Address - Phone:914-450-4038
Mailing Address - Fax:
Practice Address - Street 1:773 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5102
Practice Address - Country:US
Practice Address - Phone:860-870-1300
Practice Address - Fax:860-870-1306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043819208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001438193Medicaid
330000141Medicare PIN
I20602Medicare UPIN