Provider Demographics
NPI:1619239183
Name:PEDRENA, CHRISIE YVETTE (MSED)
Entity Type:Individual
Prefix:
First Name:CHRISIE
Middle Name:YVETTE
Last Name:PEDRENA
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:CHRISSY
Other - Middle Name:YVETTE
Other - Last Name:PEDRENA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSED
Mailing Address - Street 1:2103 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-5423
Mailing Address - Country:US
Mailing Address - Phone:212-724-8786
Mailing Address - Fax:
Practice Address - Street 1:60 MADISON AVE
Practice Address - Street 2:8TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-1600
Practice Address - Country:US
Practice Address - Phone:212-684-0099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1329058174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist