Provider Demographics
NPI:1790228708
Name:ADE, CHRISTINE (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:ADE
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W 57TH ST STE 2421
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10107-2402
Mailing Address - Country:US
Mailing Address - Phone:212-326-8462
Mailing Address - Fax:
Practice Address - Street 1:2121 LEIGHTON RD
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-3513
Practice Address - Country:US
Practice Address - Phone:516-263-9405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003276-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer