Provider Demographics
NPI:1215251616
Name:KANTARES, NANCY CAROL (LMT)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:CAROL
Last Name:KANTARES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28-42 215 PLACE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360
Mailing Address - Country:US
Mailing Address - Phone:917-806-8263
Mailing Address - Fax:
Practice Address - Street 1:59-11 161 STREET
Practice Address - Street 2:
Practice Address - City:FRESH MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11365
Practice Address - Country:US
Practice Address - Phone:917-806-8263
Practice Address - Fax:718-445-2339
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020335-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist