Provider Demographics
NPI:1144760356
Name:GO, CHRISTINE L (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:L
Last Name:GO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 S MARGINAL RD
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1914
Mailing Address - Country:US
Mailing Address - Phone:646-919-9339
Mailing Address - Fax:866-886-6638
Practice Address - Street 1:315 MADISON AVE # 1200
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5457
Practice Address - Country:US
Practice Address - Phone:646-919-9339
Practice Address - Fax:866-886-6638
Is Sole Proprietor?:No
Enumeration Date:2017-03-07
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340885363LF0000X
NY340885-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily