Provider Demographics
NPI:1194482588
Name:YIP, CHRISTINE (MS, RD, CDCES)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:YIP
Suffix:
Gender:F
Credentials:MS, RD, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MARGARET RD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-1905
Mailing Address - Country:US
Mailing Address - Phone:917-495-9967
Mailing Address - Fax:
Practice Address - Street 1:15 MARGARET RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-1905
Practice Address - Country:US
Practice Address - Phone:917-495-9967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-20
Last Update Date:2021-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86022194133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered