Healthcare Provider Details

I. General information

NPI: 1194517979
Provider Name (Legal Business Name): CHRISTIE DUVAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 ROCKVILLE AVE
ROCKVILLE CENTRE NY
11570-5535
US

IV. Provider business mailing address

14 ROCKVILLE AVE
ROCKVILLE CENTRE NY
11570-5535
US

V. Phone/Fax

Practice location:
  • Phone: 516-459-4782
  • Fax:
Mailing address:
  • Phone: 516-459-4782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number793454
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: