Healthcare Provider Details

I. General information

NPI: 1528029741
Provider Name (Legal Business Name): CHRISTOPHER BALDUCCI PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 BROADWAY SUITE 2
GREENLAWN NY
11740-1328
US

IV. Provider business mailing address

92 BROADWAY SUITE 2
GREENLAWN NY
11740-1328
US

V. Phone/Fax

Practice location:
  • Phone: 631-262-7855
  • Fax: 631-262-7854
Mailing address:
  • Phone: 631-262-7855
  • Fax: 631-262-7854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number015237-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: