Provider Demographics
NPI:1265761308
Name:VASSALLO, CHRISTINA PICARA (LAC, MSTOM)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:PICARA
Last Name:VASSALLO
Suffix:
Gender:F
Credentials:LAC, MSTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W 49TH ST
Mailing Address - Street 2:#811
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-7391
Mailing Address - Country:US
Mailing Address - Phone:215-880-9285
Mailing Address - Fax:
Practice Address - Street 1:300 W 49TH ST
Practice Address - Street 2:#811
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-7391
Practice Address - Country:US
Practice Address - Phone:215-880-9285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004236171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist