Provider Demographics
NPI:1548469604
Name:MIHAILA, CHRISTINE J (PHD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:J
Last Name:MIHAILA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:J
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:65 BROADWAY STE 842
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-2503
Mailing Address - Country:US
Mailing Address - Phone:347-994-8855
Mailing Address - Fax:
Practice Address - Street 1:65 BROADWAY
Practice Address - Street 2:STE 842
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-2503
Practice Address - Country:US
Practice Address - Phone:347-994-8855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017224103T00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03130605Medicaid
NYA300001752Medicare PIN