Healthcare Provider Details

I. General information

NPI: 1578437406
Provider Name (Legal Business Name): CHRISTOPHER F FAVAZZA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 10/02/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5958 NY-25A
WADING RIVER NY
11792
US

IV. Provider business mailing address

3 BRI CT
NESCONSET NY
11767-2062
US

V. Phone/Fax

Practice location:
  • Phone: 516-745-8050
  • Fax:
Mailing address:
  • Phone: 631-487-0806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: