Provider Demographics
NPI:1124841796
Name:BURGWIN, CHRISTINE B
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:B
Last Name:BURGWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 E 112TH ST APT 301
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-0308
Mailing Address - Country:US
Mailing Address - Phone:718-791-3235
Mailing Address - Fax:
Practice Address - Street 1:720 BEACH 20TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-3502
Practice Address - Country:US
Practice Address - Phone:718-327-7002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty