Provider Demographics
NPI:1639327091
Name:DELLARATTA, CHRISTIANNE (OPTICIAN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIANNE
Middle Name:
Last Name:DELLARATTA
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 ROUTE 112
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-3387
Mailing Address - Country:US
Mailing Address - Phone:631-476-3500
Mailing Address - Fax:631-331-1497
Practice Address - Street 1:1010 ROUTE 112
Practice Address - Street 2:SUITE 300
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-3387
Practice Address - Country:US
Practice Address - Phone:631-476-3500
Practice Address - Fax:631-331-1497
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008508-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician