Provider Demographics
NPI:1710123849
Name:KIELTYKA, CONSTANCE (CNM)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:
Last Name:KIELTYKA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MS
Other - First Name:CONSTANCE
Other - Middle Name:
Other - Last Name:KIELTYKA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:523 BEAVERKILL RD
Mailing Address - Street 2:
Mailing Address - City:OLIVEBRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:12461-5705
Mailing Address - Country:US
Mailing Address - Phone:845-657-5899
Mailing Address - Fax:
Practice Address - Street 1:523 BEAVERKILL RD
Practice Address - Street 2:
Practice Address - City:OLIVEBRIDGE
Practice Address - State:NY
Practice Address - Zip Code:12461-5705
Practice Address - Country:US
Practice Address - Phone:845-657-5899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-18
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420906-1363LW0102X
NYF001328-1367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health