Provider Demographics
NPI:1396110367
Name:MCGOVERN, CHRISTINE J (LMT)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:J
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 STAPLES ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-4104
Mailing Address - Country:US
Mailing Address - Phone:631-796-7842
Mailing Address - Fax:
Practice Address - Street 1:6 WESTON ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-4031
Practice Address - Country:US
Practice Address - Phone:631-796-7842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028015225700000X
NC14505225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist