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General NPI Number Information
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NPI Number | 1134293921
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Entity Type | Individual
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Provider Name | CHRISTOPHER JOSEPH HILDEBRANDT ATC
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Gender | Male
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 760 MAIN ST STE 1-2
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City | CENTER MORICHES
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State | NY
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Zip | 11934-2230
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Country | US
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Telephone | 631-878-4710
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Fax | 631-878-8740
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Provider Business Mailing Address
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Address Line | 20 VASSAR PL
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City | SMITHTOWN
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State | NY
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Zip | 11787-3425
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Country | US
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Telephone | 631-265-1093
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Fax | 631-878-8740
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 001319
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License Number State | NY
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