Healthcare Provider Details

I. General information

NPI: 1326028325
Provider Name (Legal Business Name): CHRISTINE D SQUERI OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 5TH AVE # 1C
NEW YORK NY
10128
US

IV. Provider business mailing address

1080 5TH AVE # 1C
NEW YORK NY
10128-0102
US

V. Phone/Fax

Practice location:
  • Phone: 609-577-8542
  • Fax:
Mailing address:
  • Phone: 609-577-8542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberTUV008553-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: