Healthcare Provider Details

I. General information

NPI: 1407982952
Provider Name (Legal Business Name): CHRISTINE J SKORDELES DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 5TH AVE RM 625
NEW YORK NY
10176-0625
US

IV. Provider business mailing address

551 5TH AVE RM 625
NEW YORK NY
10176-0625
US

V. Phone/Fax

Practice location:
  • Phone: 212-682-3170
  • Fax:
Mailing address:
  • Phone: 212-682-3170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number046930
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: