Provider Demographics
NPI:1679518617
Name:PANETTA, CHRISTINA M (PT)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:M
Last Name:PANETTA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 CANTERBURY CT
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-2264
Mailing Address - Country:US
Mailing Address - Phone:631-665-4560
Mailing Address - Fax:631-665-7213
Practice Address - Street 1:225 HOWELLS RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-5319
Practice Address - Country:US
Practice Address - Phone:631-665-4560
Practice Address - Fax:631-665-7213
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009077-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ63951Medicare PIN
NYA400019887Medicare PIN