Provider Demographics
NPI:1962717512
Name:ARKALI, CHRISTINE A (ANP)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:A
Last Name:ARKALI
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:MISS
Other - First Name:CHRISTINE
Other - Middle Name:A
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:76 SOUTHAVEN AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-3745
Mailing Address - Country:US
Mailing Address - Phone:631-447-8860
Mailing Address - Fax:631-447-8862
Practice Address - Street 1:76 SOUTHAVEN AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-3745
Practice Address - Country:US
Practice Address - Phone:631-447-8860
Practice Address - Fax:631-447-8862
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305484363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health