Healthcare Provider Details

I. General information

NPI: 1891601977
Provider Name (Legal Business Name): ELEN C KONSTAS L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 BROADHOLLOW RD STE 10
MELVILLE NY
11747-4920
US

IV. Provider business mailing address

110 S WOODS RD
WOODBURY NY
11797-1012
US

V. Phone/Fax

Practice location:
  • Phone: 631-990-4352
  • Fax:
Mailing address:
  • Phone: 917-995-7442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number007972
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: