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General NPI Number Information
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NPI Number | 1336770783
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Entity Type | Individual
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Provider Name | CHRISTOPHER M LOUCAS
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Gender | Male
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Dates
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Enumeration Date | 02/03/2020
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Last Update Date | 07/09/2021
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Provider Practice Location Address
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Address Line | 3438 BELTAGH AVE
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City | WANTAGH
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State | NY
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Zip | 11793-2552
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Country | US
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Telephone | 516-732-9706
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Fax |
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Provider Business Mailing Address
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Address Line | 3438 BELTAGH AVE
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City | WANTAGH
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State | NY
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Zip | 11793-2552
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Country | US
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Telephone | 516-732-9706
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 026188
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License Number State | NY
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