Healthcare Provider Details

I. General information

NPI: 1619736956
Provider Name (Legal Business Name): CHRISTOPHER JOHNSON CHAPLAIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 HIGHVIEW AVE APT 1
STAMFORD CT
06907-1443
US

IV. Provider business mailing address

130 W KINGSBRIDGE RD
BRONX NY
10468-3904
US

V. Phone/Fax

Practice location:
  • Phone: 646-713-6754
  • Fax:
Mailing address:
  • Phone: 718-584-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: