Provider Demographics
NPI:1750550182
Name:BARNER, CHRISTIE (LAC MSTOM)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:BARNER
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:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:CLARYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12725-0023
Mailing Address - Country:US
Mailing Address - Phone:845-986-7860
Mailing Address - Fax:
Practice Address - Street 1:44 WEST ST
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-1435
Practice Address - Country:US
Practice Address - Phone:845-986-7860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003533-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist