Healthcare Provider Details

I. General information

NPI: 1861782971
Provider Name (Legal Business Name): CHRISTINA CARPENTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2011
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY
NEW YORK NY
10032-1559
US

IV. Provider business mailing address

161 FORT WASHINGTON AVE FL 11
NEW YORK NY
10032-3729
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-9918
  • Fax: 212-342-1065
Mailing address:
  • Phone: 212-305-9918
  • Fax: 212-342-1065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number292955
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: