Provider Demographics
NPI:1912022104
Name:STENBERG, CHRISTOPHER (MBCHB)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:STENBERG
Suffix:
Gender:M
Credentials:MBCHB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2649 SOUTH RD STE 104
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-6843
Mailing Address - Country:US
Mailing Address - Phone:845-790-2085
Mailing Address - Fax:610-490-0925
Practice Address - Street 1:2649 SOUTH RD STE 104
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-6843
Practice Address - Country:US
Practice Address - Phone:845-790-2085
Practice Address - Fax:610-490-0925
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME014515208000000X, 2080P0203X
NY297586208000000X
PAMD439872208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME299720099Medicaid
NH30207539Medicaid
ME299720099Medicaid
ME000322202Medicare PIN