Healthcare Provider Details

I. General information

NPI: 1811829393
Provider Name (Legal Business Name): CHRISTINA ELYCIA CARPENTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8951 237TH ST
BELLEROSE NY
11426-1155
US

IV. Provider business mailing address

4902 QUEENS BLVD STE 2
WOODSIDE NY
11377-4445
US

V. Phone/Fax

Practice location:
  • Phone: 929-331-2782
  • Fax:
Mailing address:
  • Phone: 929-296-6790
  • Fax: 929-300-0280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: