Provider Demographics
NPI:1427202936
Name:CONSTANCE MIANECKE INC
Entity Type:Organization
Organization Name:CONSTANCE MIANECKE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIANECKE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-527-0557
Mailing Address - Street 1:PO BOX 959
Mailing Address - Street 2:
Mailing Address - City:REMSENBURG
Mailing Address - State:NY
Mailing Address - Zip Code:11960-0959
Mailing Address - Country:US
Mailing Address - Phone:516-327-0557
Mailing Address - Fax:
Practice Address - Street 1:15 WISTERIA DRIVE
Practice Address - Street 2:
Practice Address - City:REMSENBURG
Practice Address - State:NY
Practice Address - Zip Code:11960
Practice Address - Country:US
Practice Address - Phone:516-327-0557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No251B00000XAgenciesCase Management