Healthcare Provider Details

I. General information

NPI: 1508984329
Provider Name (Legal Business Name): CHRISTIANE MAGDI PACHECO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 10TH AVE ST. LUKE'S ROOSEVELT HOSPITAL CENTER, SUITE 2T
NEW YORK NY
10019-1147
US

IV. Provider business mailing address

1065 SOUTHERN BLVD
BRONX NY
10459-2417
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-6500
  • Fax: 212-523-7182
Mailing address:
  • Phone: 718-589-2440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number052514
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: