Provider Demographics
NPI:1457552291
Name:YEN, CHRISTINE
Entity type:Individual
Prefix:MISS
First Name:CHRISTINE
Middle Name:
Last Name:YEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 EDWIN AVE APT 1C
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-3619
Mailing Address - Country:US
Mailing Address - Phone:347-451-6941
Mailing Address - Fax:
Practice Address - Street 1:48 W 74TH ST
Practice Address - Street 2:THE PARKSIDE SCHOOL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2401
Practice Address - Country:US
Practice Address - Phone:212-721-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014069-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist