Provider Demographics
NPI:1699765362
Name:PETERSON EMMONS, CHRISTINE M (DPM)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:M
Last Name:PETERSON EMMONS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:19 HARNED ROAD
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725
Mailing Address - Country:US
Mailing Address - Phone:631-864-3338
Mailing Address - Fax:631-864-8166
Practice Address - Street 1:19 HARNED ROAD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725
Practice Address - Country:US
Practice Address - Phone:631-864-3338
Practice Address - Fax:631-864-8166
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN05710213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP01591Medicare ID - Type Unspecified
NYU86887Medicare UPIN