Provider Demographics
NPI:1053538181
Name:KONSTANTINOVA, NINA A (MD)
Entity type:Individual
Prefix:DR
First Name:NINA
Middle Name:A
Last Name:KONSTANTINOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6136 84TH PL
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VLG
Mailing Address - State:NY
Mailing Address - Zip Code:11379-1413
Mailing Address - Country:US
Mailing Address - Phone:718-396-2176
Mailing Address - Fax:
Practice Address - Street 1:423 W 55TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-4460
Practice Address - Country:US
Practice Address - Phone:212-994-4583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2411472084S0012X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine