Provider Demographics
NPI:1124137864
Name:CHRISTINE, ROBERT W (PA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:CHRISTINE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:891 SLEEPY HOLLOW RD UNIT 1271
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:NY
Mailing Address - Zip Code:12015-3407
Mailing Address - Country:US
Mailing Address - Phone:518-444-4380
Mailing Address - Fax:
Practice Address - Street 1:802 COLUMBIA ST
Practice Address - Street 2:SUITE 2
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-2306
Practice Address - Country:US
Practice Address - Phone:518-751-1016
Practice Address - Fax:518-751-1020
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011042363AM0700X
MA2189363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical