Provider Demographics
NPI:1659568079
Name:BREEN, CHRISTINE NOEL (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:NOEL
Last Name:BREEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 STEBBINS AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-1637
Mailing Address - Country:US
Mailing Address - Phone:718-351-6529
Mailing Address - Fax:
Practice Address - Street 1:30 PROSPECT AVE
Practice Address - Street 2:NEONATAL ICU
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1914
Practice Address - Country:US
Practice Address - Phone:201-996-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-30
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001791363A00000X
NY012810363A00000X
NJ25MP00253600363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant