Healthcare Provider Details

I. General information

NPI: 1194064527
Provider Name (Legal Business Name): CHRISTINE ANDERSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2013
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE
NEW YORK NY
10065-6007
US

IV. Provider business mailing address

158 CRESCENT PL
YONKERS NY
10704-1660
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-6924
  • Fax:
Mailing address:
  • Phone: 914-882-2675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF337431-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: