Provider Demographics
NPI:1407522048
Name:CHASE, CHRISTYN GREEN (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTYN
Middle Name:GREEN
Last Name:CHASE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CHRISTYN
Other - Middle Name:OLIVIA
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 E 48TH ST APT 6L
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-1733
Mailing Address - Country:US
Mailing Address - Phone:914-450-9340
Mailing Address - Fax:
Practice Address - Street 1:1184 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0504
Practice Address - Country:US
Practice Address - Phone:914-450-9340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY383296363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics