Provider Demographics
NPI:1649716168
Name:HABEREK-WINDHORSE, CHRISTINA ANNE (LIC AC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ANNE
Last Name:HABEREK-WINDHORSE
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:WINDHORSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LIC AC
Mailing Address - Street 1:PO BOX 1624
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:NY
Mailing Address - Zip Code:12946-5624
Mailing Address - Country:US
Mailing Address - Phone:518-524-1141
Mailing Address - Fax:
Practice Address - Street 1:1996 SARANAC AVE
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:NY
Practice Address - Zip Code:12946-1140
Practice Address - Country:US
Practice Address - Phone:518-524-1141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-07
Last Update Date:2017-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004260-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist