Healthcare Provider Details

I. General information

NPI: 1790904621
Provider Name (Legal Business Name): CHRISTINA ALICIA SWABY M.S., A.T.,C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 E 102ND ST
BROOKLYN NY
11236-2608
US

IV. Provider business mailing address

710 E 102ND ST
BROOKLYN NY
11236-2608
US

V. Phone/Fax

Practice location:
  • Phone: 917-751-3472
  • Fax:
Mailing address:
  • Phone: 917-751-3472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number001426
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: