MEDICARE: MRS. CHRISTINE A ARKALI ANP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	305484	NY

General Provider Information

NPI Number	:	1962717512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINE A ARKALI ANP

Provider Business Mailing Address
First Line	:	76 SOUTHAVEN AVE
Second Line	:	SUITE 5
City	:	MEDFORD
State	:	NY
Zip	:	11763-3745
Country	:	US
Telephone Number	:	631-447-8860
Fax Number	:	631-447-8862

Provider Business Practice Location Address
First Line	:	76 SOUTHAVEN AVE
Second Line	:	SUITE 5
City	:	MEDFORD
State	:	NY
Zip	:	11763-3745
Country	:	US
Telephone Number	:	631-447-8860
Fax Number	:	631-447-8862

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2010
Last Update Date	:	08/06/2010

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