Healthcare Provider Details

I. General information

NPI: 1184211880
Provider Name (Legal Business Name): CHRISTINE FRYE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 ROUTE 25A
MILLER PLACE NY
11764-2514
US

IV. Provider business mailing address

761 MIDDLE COUNTRY RD
SELDEN NY
11784-2550
US

V. Phone/Fax

Practice location:
  • Phone: 631-680-9458
  • Fax: 631-736-1332
Mailing address:
  • Phone: 631-736-4064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number025210-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: