Provider Demographics
NPI:1922648062
Name:CAMACHO, CHANA CHRISTINA (PA-C)
Entity Type:Individual
Prefix:
First Name:CHANA
Middle Name:CHRISTINA
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 GREENWICH ST APT 911
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-2232
Mailing Address - Country:US
Mailing Address - Phone:561-906-7348
Mailing Address - Fax:
Practice Address - Street 1:111 JOHN ST RM 1450
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-3122
Practice Address - Country:US
Practice Address - Phone:212-204-6501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024494363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant