Provider Demographics
NPI:1730384686
Name:SEO, CHRISTINA J (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:J
Last Name:SEO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:216 ENGLE ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2444
Mailing Address - Country:US
Mailing Address - Phone:201-567-7615
Mailing Address - Fax:201-567-8033
Practice Address - Street 1:216 ENGLE ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2444
Practice Address - Country:US
Practice Address - Phone:201-567-7615
Practice Address - Fax:201-567-8033
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08674700208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ201140460OtherBCBS
NJ25MA08674700OtherMEDICAL LICENSE
FLME96255OtherMEDICAL LICENSE
FLME96255OtherMEDICAL LICENSE