Provider Demographics
NPI:1457319352
Name:YAMBO, CHRISTINA M (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:YAMBO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 IRVING AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1756
Mailing Address - Country:US
Mailing Address - Phone:315-464-4686
Mailing Address - Fax:315-464-7106
Practice Address - Street 1:475 IRVING AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1756
Practice Address - Country:US
Practice Address - Phone:315-464-4686
Practice Address - Fax:315-464-7106
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234490207Q00000X
NYD80059207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02682584Medicaid
NYJ400007151Medicare PIN