Provider Demographics
NPI:1871638627
Name:MADDEN, CHRISTINE BURNEY (BS)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:BURNEY
Last Name:MADDEN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-1632
Mailing Address - Country:US
Mailing Address - Phone:516-804-5574
Mailing Address - Fax:
Practice Address - Street 1:350 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-1632
Practice Address - Country:US
Practice Address - Phone:516-804-5574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0135962251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics