Healthcare Provider Details

I. General information

NPI: 1841962438
Provider Name (Legal Business Name): CHRISTOPHER JOHN SERNAQUE NCPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 W 25TH ST FL 6
NEW YORK NY
10010-2728
US

IV. Provider business mailing address

PO BOX 23623
JACKSONVILLE FL
32241-3623
US

V. Phone/Fax

Practice location:
  • Phone: 813-591-0761
  • Fax:
Mailing address:
  • Phone: 813-591-0761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: