Provider Demographics
NPI:1801428032
Name:CHRISTIAN, ALICIA RUTH (CPNP-PC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:RUTH
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3129 PERRY AVE # 2F
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-4105
Mailing Address - Country:US
Mailing Address - Phone:347-524-4142
Mailing Address - Fax:
Practice Address - Street 1:165 MAIN ST
Practice Address - Street 2:
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-4702
Practice Address - Country:US
Practice Address - Phone:914-941-1263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY383071208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics