Provider Demographics
NPI:1386191591
Name:MINTZ, CONSTANCE (RN)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:MINTZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5240 MERRICK RD
Mailing Address - Street 2:HARMONY AT HOME
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-6207
Mailing Address - Country:US
Mailing Address - Phone:516-590-7335
Mailing Address - Fax:516-590-7338
Practice Address - Street 1:5240 MERRICK RD
Practice Address - Street 2:HARMONY AT HOME
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-6207
Practice Address - Country:US
Practice Address - Phone:516-590-7335
Practice Address - Fax:516-590-7338
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306865-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse