Basic Information
| Provider Information | |||||||||
| NPI: | 1619431459 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHRISTIAN | ||||||||
| FirstName: | JANICE | ||||||||
| MiddleName: | I | ||||||||
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| Mailing Information | |||||||||
| Address1: | JANICE CHRISTIAN | ||||||||
| Address2: | 619 MORRIS PARK AVE 2FL | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9175899274 | ||||||||
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| Practice Location | |||||||||
| Address1: | 529 COURTLANDT AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104515007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189937700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2019 | ||||||||
| LastUpdateDate: | 01/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | Y | Other Service Providers | Community Health Worker |
No ID Information.