Provider Demographics
NPI:1730564188
Name:CONSTANTINO, DIANA MARIE (APN)
Entity type:Individual
Prefix:MISS
First Name:DIANA MARIE
Middle Name:
Last Name:CONSTANTINO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SEARS DR STE 402
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-3520
Mailing Address - Country:US
Mailing Address - Phone:201-483-9188
Mailing Address - Fax:201-483-9189
Practice Address - Street 1:1 SEARS DR STE 402
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3520
Practice Address - Country:US
Practice Address - Phone:201-483-9188
Practice Address - Fax:201-483-9189
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2023-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00551300363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner