Provider Demographics
NPI:1568891570
Name:EIDINOFF, CHRISTINE (LMT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:EIDINOFF
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 ECKERT ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-3815
Mailing Address - Country:US
Mailing Address - Phone:516-316-3892
Mailing Address - Fax:
Practice Address - Street 1:52 ELM ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3489
Practice Address - Country:US
Practice Address - Phone:516-316-3892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-11
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026504225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist