Provider Demographics
NPI:1285853549
Name:CHRISTOPHE, GLADYS
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:
Last Name:CHRISTOPHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GLADYS
Other - Middle Name:NOELLE
Other - Last Name:EDPOUARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNMNPMSN
Mailing Address - Street 1:47 PINEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2419
Mailing Address - Country:US
Mailing Address - Phone:516-801-4035
Mailing Address - Fax:
Practice Address - Street 1:CROWN HEIGHTS HEALTH CENTER
Practice Address - Street 2:1167 NOSTRAND AVENUE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225
Practice Address - Country:US
Practice Address - Phone:718-778-0198
Practice Address - Fax:718-221-8169
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000131176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02230537Medicaid