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General NPI Number Information
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NPI Number | 1720402795
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Entity Type | Individual
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Provider Name | CHRISTINE PHAM DPM
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Gender | Female
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Dates
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Enumeration Date | 02/12/2014
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Last Update Date | 11/26/2018
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Provider Practice Location Address
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Address Line | 427 BROADWAY STE 2
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City | MONTICELLO
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State | NY
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Zip | 12701
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Country | US
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Telephone | 845-692-3668
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Fax |
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Provider Business Mailing Address
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Address Line | 427 BROADWAY STE 2
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City | MONTICELLO
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State | NY
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Zip | 12701-1743
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Country | US
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Telephone | 845-692-3668
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | R90568
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 006968
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License Number State | NY
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