Healthcare Provider Details

I. General information

NPI: 1891010781
Provider Name (Legal Business Name): CHRISTINE R. VIOLA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2010
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 OCEAN PKWY 4A
BROOKLYN NY
11218-4748
US

IV. Provider business mailing address

415 OCEAN PKWY 4A
BROOKLYN NY
11218-4748
US

V. Phone/Fax

Practice location:
  • Phone: 347-770-9931
  • Fax:
Mailing address:
  • Phone: 347-770-9931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberOS004850L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number263855-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: