Provider Demographics
NPI:1801641345
Name:KONSTANTATOS, MARTA (RN)
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:KONSTANTATOS
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 1:56 MISTY POND CIR APT 15
Mailing Address - Street 2:
Mailing Address - City:MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11955-1124
Mailing Address - Country:US
Mailing Address - Phone:516-471-1438
Mailing Address - Fax:
Practice Address - Street 1:528 MERRICK RD UNIT 65
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5445
Practice Address - Country:US
Practice Address - Phone:516-471-1438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY893202163WH0200X, 163WW0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1699529925Medicaid