Provider Demographics
NPI:1164736526
Name:SOBCZAK, CHRISTINA LYNN (PNP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:LYNN
Last Name:SOBCZAK
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:LYNN
Other - Last Name:LACKEMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:860 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:CORFU
Mailing Address - State:NY
Mailing Address - Zip Code:14036-9753
Mailing Address - Country:US
Mailing Address - Phone:585-599-6446
Mailing Address - Fax:585-599-3166
Practice Address - Street 1:860 MAIN ROAD
Practice Address - Street 2:
Practice Address - City:CORFU
Practice Address - State:NY
Practice Address - Zip Code:14036-9753
Practice Address - Country:US
Practice Address - Phone:585-599-6446
Practice Address - Fax:585-599-6446
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY543559-1163W00000X
NY382152363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03254235Medicaid
NY03254235Medicaid