Healthcare Provider Details

I. General information

NPI: 1124550538
Provider Name (Legal Business Name): CHRISTOPHER GEORGE LARSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 PARK AVE
BAY SHORE NY
11706-7308
US

IV. Provider business mailing address

45 PARK AVE
BAY SHORE NY
11706-7308
US

V. Phone/Fax

Practice location:
  • Phone: 631-376-0700
  • Fax: 631-376-0102
Mailing address:
  • Phone: 631-376-0700
  • Fax: 631-376-0102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number316506
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: