Provider Demographics
NPI:1275309007
Name:AGOSTO, CHRISTIAN
Entity Type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:
Last Name:AGOSTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BROWNING LN STE B2
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-3195
Mailing Address - Country:US
Mailing Address - Phone:856-724-4121
Mailing Address - Fax:
Practice Address - Street 1:102 BROWNING LN STE B2
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-3195
Practice Address - Country:US
Practice Address - Phone:856-724-4121
Practice Address - Fax:856-200-8004
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00715500225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist