Provider Demographics
NPI:1689903098
Name:JUSTINVILLE, CYNTHIA (RN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:JUSTINVILLE
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 1:11 MAYFAIR GDNS
Mailing Address - Street 2:APT 1C
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-5829
Mailing Address - Country:US
Mailing Address - Phone:631-482-2526
Mailing Address - Fax:
Practice Address - Street 1:11 MAYFAIR GDNS
Practice Address - Street 2:APT 1C
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5829
Practice Address - Country:US
Practice Address - Phone:631-482-2526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY715225163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse