Healthcare Provider Details

I. General information

NPI: 1659568079
Provider Name (Legal Business Name): CHRISTINE NOEL BREEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2007
Last Update Date: 03/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE NEONATAL ICU
HACKENSACK NJ
07601-1914
US

IV. Provider business mailing address

7 STEBBINS AVE
STATEN ISLAND NY
10310-1637
US

V. Phone/Fax

Practice location:
  • Phone: 201-996-2000
  • Fax:
Mailing address:
  • Phone: 718-351-6529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001791
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number012810
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00253600
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: