Healthcare Provider Details

I. General information

NPI: 1003489832
Provider Name (Legal Business Name): CHRISTINE RANDINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 MAIN ST
HACKENSACK NJ
07601-7143
US

IV. Provider business mailing address

209 COMLY RD APT I17
LINCOLN PARK NJ
07035-1170
US

V. Phone/Fax

Practice location:
  • Phone: 201-487-4700
  • Fax:
Mailing address:
  • Phone: 862-881-5194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37CA00127800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: