Healthcare Provider Details

I. General information

NPI: 1669190401
Provider Name (Legal Business Name): CHRISTINA KRASNAVAGE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MAIN ST
PEEKSKILL NY
10566-2907
US

IV. Provider business mailing address

845 N BROADWAY
WHITE PLAINS NY
10603-2403
US

V. Phone/Fax

Practice location:
  • Phone: 914-737-7338
  • Fax:
Mailing address:
  • Phone: 914-761-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number02852801
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6616
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: