Healthcare Provider Details

I. General information

NPI: 1295532752
Provider Name (Legal Business Name): CHRISTINE MAI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 47TH AVE
LONG ISLAND CITY NY
11101-5416
US

IV. Provider business mailing address

1041 47TH AVE
LONG ISLAND CITY NY
11101-5416
US

V. Phone/Fax

Practice location:
  • Phone: 212-385-3700
  • Fax:
Mailing address:
  • Phone: 212-385-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number035005
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: