Provider Demographics
NPI:1467899070
Name:RAFF, CHRISTINA (COTA)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:RAFF
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 KENDALL BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLYN
Mailing Address - State:NJ
Mailing Address - Zip Code:08107-1110
Mailing Address - Country:US
Mailing Address - Phone:856-952-8420
Mailing Address - Fax:
Practice Address - Street 1:168 KENDALL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLYN
Practice Address - State:NJ
Practice Address - Zip Code:08107-1110
Practice Address - Country:US
Practice Address - Phone:856-952-8420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09091800172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker