Healthcare Provider Details

I. General information

NPI: 1437014065
Provider Name (Legal Business Name): CHRISTINA PATELLOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 30TH AVE
LONG ISLAND CITY NY
11102-2448
US

IV. Provider business mailing address

2510 30TH AVE
LONG ISLAND CITY NY
11102-2418
US

V. Phone/Fax

Practice location:
  • Phone: 718-932-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number034700
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: