Healthcare Provider Details

I. General information

NPI: 1588169114
Provider Name (Legal Business Name): CHRISTIAN HURST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST PH 5-133
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

622 W 168TH ST PH 5-133
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-3226
  • Fax:
Mailing address:
  • Phone: 212-305-3226
  • Fax: 212-305-3204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number301794
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: