Provider Demographics
NPI:1316586340
Name:DEGEN, CHRISTOPHER (PT, DPT, OCS, CSCS)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:DEGEN
Suffix:
Gender:M
Credentials:PT, DPT, OCS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1058 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-3718
Mailing Address - Country:US
Mailing Address - Phone:631-379-6480
Mailing Address - Fax:
Practice Address - Street 1:3279 VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-7673
Practice Address - Country:US
Practice Address - Phone:631-580-8720
Practice Address - Fax:631-580-8727
Is Sole Proprietor?:No
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0319192251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic