Provider Demographics
NPI:1629500590
Name:DUNPHY, CHRISTINA NICOLE
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:NICOLE
Last Name:DUNPHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ASTER CT
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-6561
Mailing Address - Country:US
Mailing Address - Phone:718-934-0402
Mailing Address - Fax:
Practice Address - Street 1:120 ASTER CT
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-6561
Practice Address - Country:US
Practice Address - Phone:718-934-0402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist