Provider Demographics
NPI:1447399159
Name:GIBBONS, CHRISTINE (MS, CA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:MS, CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 W PASSAIC ST
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-3120
Mailing Address - Country:US
Mailing Address - Phone:201-843-3366
Mailing Address - Fax:201-843-0331
Practice Address - Street 1:221 W PASSAIC ST
Practice Address - Street 2:
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-3120
Practice Address - Country:US
Practice Address - Phone:201-843-3366
Practice Address - Fax:201-843-0331
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00014300171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist