Healthcare Provider Details

I. General information

NPI: 1588926273
Provider Name (Legal Business Name): MISS CHRISTINE E MINCHAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2012
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CEDAR ST
NEW ROCHELLE NY
10801-5247
US

IV. Provider business mailing address

53 HUNT AVE
PEARL RIVER NY
10965-1841
US

V. Phone/Fax

Practice location:
  • Phone: 914-576-5292
  • Fax:
Mailing address:
  • Phone: 845-461-4328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number1172777
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number000782
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: