Healthcare Provider Details

I. General information

NPI: 1396484226
Provider Name (Legal Business Name): CHRISTAL NWORJIH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2154 NEWBRIDGE RD
BELLMORE NY
11710-2239
US

IV. Provider business mailing address

2154 NEWBRIDGE RD
BELLMORE NY
11710-2239
US

V. Phone/Fax

Practice location:
  • Phone: 516-409-8800
  • Fax:
Mailing address:
  • Phone: 516-409-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number339961-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: