Healthcare Provider Details

I. General information

NPI: 1992957161
Provider Name (Legal Business Name): CHRISTINE ZIC MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2008
Last Update Date: 10/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 W 38TH ST 18TH FLOOR
NEW YORK NY
10018-5803
US

IV. Provider business mailing address

325 E 12TH ST APT 4E
NEW YORK NY
10003-7221
US

V. Phone/Fax

Practice location:
  • Phone: 212-997-7490
  • Fax:
Mailing address:
  • Phone: 212-997-7490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number025230-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: