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Provider Information for 1710116488

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

MARY CONSTANTINO NP

Other Name:   MARY GREEN
Gender: FEMALE

Individual NPI: 1710116488

Calendar   Last Updated:  2009-07-02
  Certification Date: 

Details

Name Value
NPI 1710116488
Enumeration Date 2009-07-02
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 454 MAPLE AVE
SARATOGA SPRINGS, NY 12866-5532
United States

Phone: 518-587-1141 | Fax: 518-587-1152
View Map External Link
Primary Practice Address 99 E STATE ST
GLOVERSVILLE, NY 12078-1203
United States

Phone: 518-773-5780 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
MEDICAID NY PENDING
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 363L00000X - Nurse Practitioner NY F335787