Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | N004543 | NY |
Y | 222Z00000X | Podiatrist | N004543 | NY |
N | 213EP1101X | Primary Podiatric Medicine | N004543 | NY |
N | 111NR0200X | Radiology | N004543 | NY |
N | 213ER0200X | Radiology | N004543 | NY |
N | 2081S0010X | Sports Medicine | N004543 | NY |
N | 213ES0000X | Sports Medicine | N004543 | NY |
N | 213ES0131X | Foot Surgery | N004543 | NY |
NPI | 1861587974 |
---|---|
Provider Name | Dr. Gus Constantouris |
First Address | Commack, NY 11725-3452 |
Second Address | Commack, NY 11725-3452 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 04/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U10310 | (02) | NY |