Provider Demographics
NPI:1538556543
Name:DESALVO, CHRISTOPHER (LAC RN)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:DESALVO
Suffix:
Gender:M
Credentials:LAC RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:856-677-4000
Mailing Address - Fax:856-234-3014
Practice Address - Street 1:2123 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-1003
Practice Address - Country:US
Practice Address - Phone:732-449-2001
Practice Address - Fax:732-449-2238
Is Sole Proprietor?:No
Enumeration Date:2015-04-17
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR15780100163W00000X
NJ25MY00001700171100000X
PAKO000590171100000X
NJ25MZ00110200171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163W00000XNursing Service ProvidersRegistered Nurse