Provider Demographics
NPI:1427350982
Name:EDUGENE, CHRISTINE VICTORIA (PA)
Entity type:Individual
Prefix:MISS
First Name:CHRISTINE
Middle Name:VICTORIA
Last Name:EDUGENE
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:33 OVERLOOK RD STE 201
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3562
Practice Address - Country:US
Practice Address - Phone:908-522-5045
Practice Address - Fax:908-522-5041
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-03
Last Update Date:2022-12-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY014493363AS0400X
NJ25MP00678400363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical