Healthcare Provider Details

I. General information

NPI: 1548519861
Provider Name (Legal Business Name): CHRISTINA ST JUSTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8825 163 STREET
JAMAICA NY
11432
US

IV. Provider business mailing address

4144 KINGS HWY
BROOKLYN NY
11234
US

V. Phone/Fax

Practice location:
  • Phone: 718-739-0045
  • Fax:
Mailing address:
  • Phone: 347-796-9583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number296836
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: