Individual
COLLEEN COSTANZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9 RUTH ST, SMITHTOWN, NY 11787-1227
(631) 860-4045
Mailing address
9 RUTH ST, SMITHTOWN, NY 11787-1227
(631) 860-4045
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
311720
NY
Other
Enumeration date
04/05/2013
Last updated
04/05/2013
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