Healthcare Provider Details

I. General information

NPI: 1275154023
Provider Name (Legal Business Name): CHRISTINE CHERPAK-CASTAGNA DCN, CNS, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINE CHERPAK

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 JORDAN DR
MEDFORD NY
11763-2051
US

IV. Provider business mailing address

40 JORDAN DR
MEDFORD NY
11763-2051
US

V. Phone/Fax

Practice location:
  • Phone: 516-885-4732
  • Fax:
Mailing address:
  • Phone: 516-885-4732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: