Provider Demographics
NPI:1326283227
Name:CONSTANTINO, NANCY JANE (PT)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:JANE
Last Name:CONSTANTINO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:12411-0105
Mailing Address - Country:US
Mailing Address - Phone:845-331-4716
Mailing Address - Fax:
Practice Address - Street 1:4246 ALBANY POST RD
Practice Address - Street 2:SUITE 1
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-1700
Practice Address - Country:US
Practice Address - Phone:845-229-6044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4214-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist