Basic Information
| Provider Information | |||||||||
| NPI: | 1982228979 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOUZAKITIS | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | EGERIA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12 VINTON ST | ||||||||
| Address2: | |||||||||
| City: | NORTH MASSAPEQUA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117581030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166471294 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 E MAIN ST STE 6 | ||||||||
| Address2: | |||||||||
| City: | SMITHTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117872900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312575290 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2020 | ||||||||
| LastUpdateDate: | 04/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WM0705X | 542040-1 | NY | N | Nursing Service Providers | Registered Nurse | Medical-Surgical | 363LA2200X | F309872 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.