Healthcare Provider Details

I. General information

NPI: 1942759352
Provider Name (Legal Business Name): CHRISTINE PFUNDSTEIN PNP, CCE, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 07/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SYLVAN AVE
MILLER PLACE NY
11764-2420
US

IV. Provider business mailing address

15 SYCAMORE AVE
LAKE GROVE NY
11755-2726
US

V. Phone/Fax

Practice location:
  • Phone: 631-928-4888
  • Fax:
Mailing address:
  • Phone: 516-521-2038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number383001
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number604599-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: