=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376202564
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTINE CHERPAK-CASTAGNA DOCTOR OF CLINICAL NUTRITION, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2021
-----------------------------------------------------
Last Update Date | 12/15/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 JORDAN DR
-----------------------------------------------------
City | MEDFORD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11763-2051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-885-4732
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 40 JORDAN DR
-----------------------------------------------------
City | MEDFORD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11763-2051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/NUTRITIONIST
-----------------------------------------------------
Name | CHRISTINE CHERPAK-CASTAGNA
-----------------------------------------------------
Credential | DCN, CNS, CDN
-----------------------------------------------------
Telephone | 516-885-4732
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133NN1002X
-----------------------------------------------------
Taxonomy Name | Nutrition Education Nutritionist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 133N00000X
-----------------------------------------------------
Taxonomy Name | Nutritionist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------