Provider Demographics
NPI:1427311257
Name:SMITH, CONSTANCE ANN (MS)
Entity type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:CONNIE
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7 JAY CT
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-1465
Mailing Address - Country:US
Mailing Address - Phone:631-589-3458
Mailing Address - Fax:
Practice Address - Street 1:7 JAY CT
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-1465
Practice Address - Country:US
Practice Address - Phone:631-589-3458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist