Provider Demographics
NPI:1225324676
Name:ADAN, CHRISTINE JOY R (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE JOY
Middle Name:R
Last Name:ADAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 NORTHERN BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4058
Mailing Address - Country:US
Mailing Address - Phone:516-466-9300
Mailing Address - Fax:516-466-9353
Practice Address - Street 1:55 NORTHERN BLVD STE 103
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4058
Practice Address - Country:US
Practice Address - Phone:516-466-9300
Practice Address - Fax:516-466-9353
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031818225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400051036Medicare PIN
NYA400050755Medicare PIN
NYA400051708Medicare PIN
NYA400050893Medicare PIN