Provider Demographics
NPI:1528029741
Name:BALDUCCI, CHRISTOPHER (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:BALDUCCI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 BROADWAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740-1328
Mailing Address - Country:US
Mailing Address - Phone:631-262-7855
Mailing Address - Fax:631-262-7854
Practice Address - Street 1:92 BROADWAY
Practice Address - Street 2:SUITE 2
Practice Address - City:GREENLAWN
Practice Address - State:NY
Practice Address - Zip Code:11740-1328
Practice Address - Country:US
Practice Address - Phone:631-262-7855
Practice Address - Fax:631-262-7854
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015237-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ31X51Medicare ID - Type Unspecified