Provider Demographics
NPI:1003369281
Name:COLOMBO, CHRISTINA
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:
Last Name:COLOMBO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:POTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18 LONGSTREET DR
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-2315
Mailing Address - Country:US
Mailing Address - Phone:631-662-7994
Mailing Address - Fax:
Practice Address - Street 1:18 LONGSTREET DR
Practice Address - Street 2:
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-2315
Practice Address - Country:US
Practice Address - Phone:631-662-7994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist