Provider Demographics
NPI:1396703369
Name:CHRISTINE FORSZPANIAK INC
Entity type:Organization
Organization Name:CHRISTINE FORSZPANIAK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FORSZPANIAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-434-7779
Mailing Address - Street 1:848 1ST AVE N
Mailing Address - Street 2:SUITE 230
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-6013
Mailing Address - Country:US
Mailing Address - Phone:239-434-7779
Mailing Address - Fax:239-434-7588
Practice Address - Street 1:848 1ST AVE N
Practice Address - Street 2:SUITE 230
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-6013
Practice Address - Country:US
Practice Address - Phone:239-434-7779
Practice Address - Fax:239-434-7588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 49793174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064785300Medicaid
FL110050893OtherRAIL ROAD MEDICARE
FLDN646AOtherMEDICARE
FLP1107159OtherOXFORD
FLP1107159OtherOXFORD