Healthcare Provider Details

I. General information

NPI: 1912157496
Provider Name (Legal Business Name): CHRISTINE MARIE FUCA C.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2008
Last Update Date: 09/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 MORRISON AVENUE SUPERIOR CLINICAL CARE PLLC
STATEN ISLAND NY
10310
US

IV. Provider business mailing address

93 BURDEN AVE
STATEN ISLAND NY
10302-1621
US

V. Phone/Fax

Practice location:
  • Phone: 718-442-3646
  • Fax:
Mailing address:
  • Phone: 718-981-8489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number004328
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: