Provider Demographics
NPI:1144313495
Name:DANZI-HACKEN, CHRISTINE MARIE (DO)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:MARIE
Last Name:DANZI-HACKEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:MARIE
Other - Last Name:DANZI-HACKEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:340 VETERANS MEMORIAL HWY
Mailing Address - Street 2:SUITE 10
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4300
Mailing Address - Country:US
Mailing Address - Phone:631-864-6440
Mailing Address - Fax:631-864-6445
Practice Address - Street 1:340 VETERANS MEMORIAL HWY
Practice Address - Street 2:SUITE 10
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4300
Practice Address - Country:US
Practice Address - Phone:631-864-6440
Practice Address - Fax:631-864-6445
Is Sole Proprietor?:No
Enumeration Date:2006-10-01
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220679208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02351297Medicaid
NYH76137Medicare UPIN