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General NPI Number Information
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NPI Number | 1932282373
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Entity Type | Individual
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Provider Name | CHRISTINA MICHELLE WAINER PA
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Gender | Female
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Dates
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Enumeration Date | 10/21/2006
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Last Update Date | 09/13/2022
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Provider Practice Location Address
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Address Line | 173 MINEOLA BLVD
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City | MINEOLA
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State | NY
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Zip | 11501-2528
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Country | US
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Telephone | 516-663-1950
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Fax |
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Provider Business Mailing Address
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Address Line | 7901 BROADWAY MANAGED CARE, D1-01
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City | ELMHURST
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State | NY
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Zip | 11373-1329
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Country | US
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Telephone | 718-334-1921
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Fax | 718-334-3432
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 008877
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License Number State | NY
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