Provider Demographics
NPI:1902495773
Name:CHRISTINE M. DANZI - HACKEN PEDIATRIC MEDICINE PC
Entity Type:Organization
Organization Name:CHRISTINE M. DANZI - HACKEN PEDIATRIC MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DANZI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-864-6440
Mailing Address - Street 1:994 W JERICHO TPKE STE 202
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3234
Mailing Address - Country:US
Mailing Address - Phone:631-864-6440
Mailing Address - Fax:631-864-6445
Practice Address - Street 1:994 W JERICHO TPKE STE 202
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3234
Practice Address - Country:US
Practice Address - Phone:631-864-6440
Practice Address - Fax:631-864-6445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-15
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty