Provider Demographics
NPI:1508859406
Name:JELALIAN, CHRISTINE ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:ELIZABETH
Last Name:JELALIAN
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 1:21 LAUREL AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:CORNWALL
Mailing Address - State:NY
Mailing Address - Zip Code:12518-1476
Mailing Address - Country:US
Mailing Address - Phone:845-237-7050
Mailing Address - Fax:845-237-7060
Practice Address - Street 1:21 LAUREL AVE STE 260
Practice Address - Street 2:
Practice Address - City:CORNWALL
Practice Address - State:NY
Practice Address - Zip Code:12518-1476
Practice Address - Country:US
Practice Address - Phone:845-237-7050
Practice Address - Fax:845-237-7060
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142402-12086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00890886Medicaid
NY00890886Medicaid
NY49D881Medicare ID - Type Unspecified