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General NPI Number Information
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NPI Number | 1134408602
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Entity Type | Individual
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Provider Name | CHRISTY K DEFOURNOY
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Gender | Male
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Dates
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Enumeration Date | 08/15/2011
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Last Update Date | 01/06/2022
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Provider Practice Location Address
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Address Line | 68 JEFFERSON AVE
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City | BAY SHORE
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State | NY
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Zip | 11706-5760
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Country | US
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Telephone | 631-482-0219
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Fax |
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Provider Business Mailing Address
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Address Line | 2053 23RD ST
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City | ASTORIA
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State | NY
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Zip | 11105-3245
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Country | US
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Telephone | 631-626-6796
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 347189
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License Number State | NY
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