Provider Demographics
NPI:1447399605
Name:MICHELCIC, CRISTINA (SPECIAL ED TEACHER)
Entity Type:Individual
Prefix:MRS
First Name:CRISTINA
Middle Name:
Last Name:MICHELCIC
Suffix:
Gender:F
Credentials:SPECIAL ED TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 N COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2067
Mailing Address - Country:US
Mailing Address - Phone:631-360-3498
Mailing Address - Fax:
Practice Address - Street 1:349 N COUNTRY RD
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2067
Practice Address - Country:US
Practice Address - Phone:631-360-3498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)