Healthcare Provider Details

I. General information

NPI: 1639197130
Provider Name (Legal Business Name): CHRISTINE M O'HAGAN CARLIN RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 BEACH 134TH ST
BELLE HARBOR NY
11694-1440
US

IV. Provider business mailing address

238 BEACH 134TH ST
BELLE HARBOR NY
11694-1440
US

V. Phone/Fax

Practice location:
  • Phone: 631-355-4646
  • Fax: 718-474-7957
Mailing address:
  • Phone: 631-355-4646
  • Fax: 718-474-7957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number007082
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: