Provider Demographics
NPI:1376202564
Name:CHRISTINE CHERPAK-CASTAGNA DOCTOR OF CLINICAL NUTRITION, P.C.
Entity Type:Organization
Organization Name:CHRISTINE CHERPAK-CASTAGNA DOCTOR OF CLINICAL NUTRITION, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERPAK-CASTAGNA
Authorized Official - Suffix:
Authorized Official - Credentials:DCN, CNS, CDN
Authorized Official - Phone:516-885-4732
Mailing Address - Street 1:40 JORDAN DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-2051
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 JORDAN DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-2051
Practice Address - Country:US
Practice Address - Phone:516-885-4732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty