Doctor Name: | CHRISTINA DANGERVIL |
NPI Number: | 1154606648 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA, RPAC |
License Number: | 014919 |
Business Practice Address: | 3 California Pl S Island Park, NY - 115582216 |
Business Phone Number: | 5166708800 |
Business Fax Number: | 5166708803 |
Mailing Address: | 253-18 148 Road, ROSEDALE |
State: | NY |
Postal Code: | 11422 |
Phone Number: | 6465102388 |
Fax Number: | |
NPI Enumeration Date: | 10/15/2011 |
NPI Last Update Date: | 05/06/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 014919 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |