Provider Demographics
NPI:1134369440
Name:CARDEN, CHRISTOPHER KEVIN (DPT)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:KEVIN
Last Name:CARDEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SAINT NICHOLAS AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-2004
Mailing Address - Country:US
Mailing Address - Phone:631-738-9018
Mailing Address - Fax:
Practice Address - Street 1:12 SAINT NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-2004
Practice Address - Country:US
Practice Address - Phone:631-738-9018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013841-12251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics