Provider Demographics
NPI:1164854162
Name:HEATHER A. COSTANZO-MELLONE, LLC
Entity Type:Organization
Organization Name:HEATHER A. COSTANZO-MELLONE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TEACHER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTANZO-MELLONE
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:718-375-8586
Mailing Address - Street 1:1746 COLEMAN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4313
Mailing Address - Country:US
Mailing Address - Phone:718-375-8586
Mailing Address - Fax:718-375-8586
Practice Address - Street 1:1746 COLEMAN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-4313
Practice Address - Country:US
Practice Address - Phone:718-375-8586
Practice Address - Fax:718-375-8586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty