Provider Demographics
NPI:1972114262
Name:CANTONE, KEVIN A (RN)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:A
Last Name:CANTONE
Suffix:
Gender:M
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 STRAFFORD ST
Mailing Address - Street 2:
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950-4510
Mailing Address - Country:US
Mailing Address - Phone:631-512-1651
Mailing Address - Fax:
Practice Address - Street 1:212 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2841
Practice Address - Country:US
Practice Address - Phone:631-369-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY797239163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse