Healthcare Provider Details

I. General information

NPI: 1821743295
Provider Name (Legal Business Name): CHRISTIE RODE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 03/12/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 MONTAUK HWY
SHIRLEY NY
11967-2114
US

IV. Provider business mailing address

38 PINEHURST DR
MOUNT SINAI NY
11766-3421
US

V. Phone/Fax

Practice location:
  • Phone: 631-490-3040
  • Fax: 631-490-3055
Mailing address:
  • Phone: 631-220-6873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number058738
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number099481
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: