MEDICARE: CHRISTINE MORDENTE M.ED.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	204417	NY

General Provider Information

NPI Number	:	1104211325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE MORDENTE M.ED.

Provider Business Mailing Address
First Line	:	3352 85TH ST
Second Line	:	APT. 405
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-1528
Country	:	US
Telephone Number	:	518-727-1507
Fax Number	:

Provider Business Practice Location Address
First Line	:	3352 85TH ST
Second Line	:	APT. 405
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-1528
Country	:	US
Telephone Number	:	518-727-1507
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2015
Last Update Date	:	04/03/2015

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