Provider Demographics
NPI:1497811814
Name:CECOT, CHRISTINE (PT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:
Last Name:CECOT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 ANDREWS ST
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-3401
Mailing Address - Country:US
Mailing Address - Phone:315-769-9908
Mailing Address - Fax:315-764-5430
Practice Address - Street 1:271 ANDREWS ST
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-3401
Practice Address - Country:US
Practice Address - Phone:315-769-9908
Practice Address - Fax:315-764-5430
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0060991174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01216540Medicaid
NY0060991OtherLICENSE NUMBER
NY01216540Medicaid