Provider Demographics
NPI:1104211325
Name:MORDENTE, CHRISTINE (MED)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:MORDENTE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3352 85TH ST
Mailing Address - Street 2:APT. 405
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-1528
Mailing Address - Country:US
Mailing Address - Phone:518-727-1507
Mailing Address - Fax:
Practice Address - Street 1:3352 85TH ST
Practice Address - Street 2:APT. 405
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-1528
Practice Address - Country:US
Practice Address - Phone:518-727-1507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204417174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist