Provider Demographics
NPI:1477707172
Name:HAGERTY, CHRISTINE DELUCA (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:DELUCA
Last Name:HAGERTY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:DELUCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:403 LITTLE EAST NECK RD
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-6518
Mailing Address - Country:US
Mailing Address - Phone:631-716-5463
Mailing Address - Fax:
Practice Address - Street 1:403 LITTLE EAST NECK RD
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-6518
Practice Address - Country:US
Practice Address - Phone:631-716-5463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012974363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant