Provider Demographics
NPI:1700284346
Name:FANITA, CRISTINA (RT)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:FANITA
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:CRISTINA
Other - Middle Name:
Other - Last Name:GHEOGHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4915 SKILLMAN AVE
Mailing Address - Street 2:APT 1D
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4169
Mailing Address - Country:US
Mailing Address - Phone:646-269-0001
Mailing Address - Fax:
Practice Address - Street 1:800 POLY PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7104
Practice Address - Country:US
Practice Address - Phone:718-630-3605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-14
Last Update Date:2014-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5126102471R0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471R0002XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiation Therapy