Provider Demographics
NPI:1710990023
Name:LANDES, CHRISTINE M (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:LANDES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 ROUTE 33
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07754
Mailing Address - Country:US
Mailing Address - Phone:732-776-4292
Mailing Address - Fax:732-776-2428
Practice Address - Street 1:1945 STATE ROUTE 33
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4859
Practice Address - Country:US
Practice Address - Phone:732-776-4292
Practice Address - Fax:732-776-2428
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00026900164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJQ38045Medicare UPIN
NJ088725UVPMedicare PIN