Healthcare Provider Details

I. General information

NPI: 1801428032
Provider Name (Legal Business Name): ALICIA RUTH CHRISTIAN CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 MAIN ST
OSSINING NY
10562-4702
US

IV. Provider business mailing address

3129 PERRY AVE # 2F
BRONX NY
10467-4105
US

V. Phone/Fax

Practice location:
  • Phone: 914-941-1263
  • Fax:
Mailing address:
  • Phone: 347-524-4142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number383071
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: