Provider Demographics
NPI:1962868216
Name:MULLEN, CRISTIN
Entity type:Individual
Prefix:
First Name:CRISTIN
Middle Name:
Last Name:MULLEN
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 1:543 BEACH 130TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLE HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1530
Mailing Address - Country:US
Mailing Address - Phone:917-596-5678
Mailing Address - Fax:
Practice Address - Street 1:4024 AMBOY RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-2409
Practice Address - Country:US
Practice Address - Phone:718-984-9022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-01
Last Update Date:2016-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist