Provider Demographics
NPI:1841569845
Name:GIBBONS, CHRISTINE (LAC)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 CARY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-2044
Mailing Address - Country:US
Mailing Address - Phone:347-574-7969
Mailing Address - Fax:
Practice Address - Street 1:694 CLOVE RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-2707
Practice Address - Country:US
Practice Address - Phone:718-448-3412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004608-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist