Provider Demographics
NPI:1508356338
Name:LEVI, CHRISTINA (LAC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:LEVI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-2733
Mailing Address - Country:US
Mailing Address - Phone:631-926-6356
Mailing Address - Fax:631-828-1765
Practice Address - Street 1:34 SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-2733
Practice Address - Country:US
Practice Address - Phone:631-926-6356
Practice Address - Fax:631-828-1765
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027650225700000X
NY006279171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist