Provider Demographics
NPI:1063941946
Name:PASSEN, CHRISTINE ANNE (MPH, RDN, CDN)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANNE
Last Name:PASSEN
Suffix:
Gender:F
Credentials:MPH, RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 BROADWAY STE 202
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-4271
Mailing Address - Country:US
Mailing Address - Phone:518-584-1777
Mailing Address - Fax:518-584-1666
Practice Address - Street 1:268 BROADWAY STE 202
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-4271
Practice Address - Country:US
Practice Address - Phone:518-584-1777
Practice Address - Fax:518-584-1666
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008848133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered