Provider Demographics
NPI:1336353325
Name:GANZER, CHRISTINE ANNE (NPP)
Entity Type:Individual
Prefix:PROF
First Name:CHRISTINE
Middle Name:ANNE
Last Name:GANZER
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:ANNE
Other - Last Name:GANZER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NPP
Mailing Address - Street 1:27 BEACON HILL RD
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-3031
Mailing Address - Country:US
Mailing Address - Phone:516-944-7747
Mailing Address - Fax:516-944-6644
Practice Address - Street 1:120 E 56TH ST RM 1040
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3651
Practice Address - Country:US
Practice Address - Phone:212-888-0002
Practice Address - Fax:212-888-1899
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY40-400873363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health