Provider Demographics
NPI:1245880293
Name:BANTIGUE, CHRISTIAN (COTA)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:BANTIGUE
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6945 108TH ST APT 9E
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3836
Mailing Address - Country:US
Mailing Address - Phone:201-742-2836
Mailing Address - Fax:
Practice Address - Street 1:107 NORTHERN BLVD STE 308
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4309
Practice Address - Country:US
Practice Address - Phone:516-504-4263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant