Basic Information
Provider Information | |||||||||
NPI: | 1811008600 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MCGAFFIN | ||||||||
FirstName: | CHRISTINA | ||||||||
MiddleName: | E | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | RN,MS,ANP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 711 TROY SCHENECTADY RD STE 203 | ||||||||
Address2: |   | ||||||||
City: | LATHAM | ||||||||
State: | NY | ||||||||
PostalCode: | 121102461 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5187823700 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2546 BALLTOWN RD | ||||||||
Address2: | SUITE 200 | ||||||||
City: | SCHENECTADY | ||||||||
State: | NY | ||||||||
PostalCode: | 123091079 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5183741444 | ||||||||
FaxNumber: | 5183740491 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/31/2006 | ||||||||
LastUpdateDate: | 01/31/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | F304141 | NY | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   |
ID Information
ID | Type | State | Issuer | Description | 070326000072 | 01 | NY | FIDELIS | OTHER | 375903 | 01 | NY | MVP HEALTHCARE | OTHER | 200561 | 01 | NY | SENIOR WHOLE HEALTH | OTHER | 02631381 | 05 | NY |   | MEDICAID | 87321 | 01 | NY | GHI/HMO | OTHER | 000408305001 | 01 | NY | BSNENY | OTHER |