Healthcare Provider Details

I. General information

NPI: 1518416874
Provider Name (Legal Business Name): DR. CHRISTINA MARIE BIONDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 CLARK DR
EAST BERLIN CT
06023-1157
US

IV. Provider business mailing address

5 SCOTT LN
CROMWELL CT
06416-1270
US

V. Phone/Fax

Practice location:
  • Phone: 888-319-1818
  • Fax: 844-381-9685
Mailing address:
  • Phone: 860-212-1187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11336
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: