Provider Demographics
NPI:1982932158
Name:MADU, CONSTANCE (NP)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:MADU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 RESEARCH WAY STE 500
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3470
Mailing Address - Country:US
Mailing Address - Phone:631-444-6270
Mailing Address - Fax:631-444-7620
Practice Address - Street 1:24 RESEARCH WAY STE 500
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3470
Practice Address - Country:US
Practice Address - Phone:631-444-6270
Practice Address - Fax:631-444-7620
Is Sole Proprietor?:No
Enumeration Date:2009-11-30
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY343479363LF0000X
NY619181163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse