Healthcare Provider Details

I. General information

NPI: 1053045856
Provider Name (Legal Business Name): CHRISTY AQUILINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 BURKE LN
SYOSSET NY
11791-3932
US

IV. Provider business mailing address

15 BURKE LN
SYOSSET NY
11791-3932
US

V. Phone/Fax

Practice location:
  • Phone: 516-496-6400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number689537-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: