Provider Demographics
NPI:1295119519
Name:NIESSING, CHRISTOPHER BRIAN (LMT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:BRIAN
Last Name:NIESSING
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2780 MIDDLE COUNTRY RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-2124
Mailing Address - Country:US
Mailing Address - Phone:631-580-1000
Mailing Address - Fax:631-580-0483
Practice Address - Street 1:10 OLD RIVERHEAD RD UNIT A
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON BEACH
Practice Address - State:NY
Practice Address - Zip Code:11978-1460
Practice Address - Country:US
Practice Address - Phone:631-369-4292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2022-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001621171100000X
NY009123225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171100000XOther Service ProvidersAcupuncturist