Healthcare Provider Details

I. General information

NPI: 1093913618
Provider Name (Legal Business Name): CHRISTINA RANAE ALFONSO RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 BRIGGS HWY
ELLENVILLE NY
12428-5501
US

IV. Provider business mailing address

253 SINSABAUGH RD
PINE BUSH NY
12566-5428
US

V. Phone/Fax

Practice location:
  • Phone: 845-647-4509
  • Fax: 845-647-2302
Mailing address:
  • Phone: 845-744-5685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number021248
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: