Healthcare Provider Details

I. General information

NPI: 1801641345
Provider Name (Legal Business Name): MARTA KONSTANTATOS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2024
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 MERRICK RD UNIT 65
ROCKVILLE CENTRE NY
11570-5445
US

IV. Provider business mailing address

56 MISTY POND CIR APT 15
MORICHES NY
11955-1124
US

V. Phone/Fax

Practice location:
  • Phone: 516-471-1438
  • Fax:
Mailing address:
  • Phone: 516-471-1438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number893202
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number893202
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number893202
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: