Provider Demographics
NPI:1417484494
Name:FORDE, CHRISTINA JULIANA (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JULIANA
Last Name:FORDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:FORDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11506 BEACH CHANNEL DR STE 202
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2113
Mailing Address - Country:US
Mailing Address - Phone:718-318-6021
Mailing Address - Fax:708-318-4082
Practice Address - Street 1:11506 BEACH CHANNEL DR STE 202
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2113
Practice Address - Country:US
Practice Address - Phone:718-318-6021
Practice Address - Fax:718-318-4802
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304707207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine