Provider Demographics
NPI:1669823696
Name:TADA, CHRISTINE (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:TADA
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 1:24936 THEBES AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1336
Mailing Address - Country:US
Mailing Address - Phone:718-281-0204
Mailing Address - Fax:
Practice Address - Street 1:1776 BROADWAY
Practice Address - Street 2:#1200
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2002
Practice Address - Country:US
Practice Address - Phone:212-707-8662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019405-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant