Provider Demographics
NPI:1871042242
Name:GRAZIANO-EBERHARDT, CHRISTINE RITA (MS)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:RITA
Last Name:GRAZIANO-EBERHARDT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:RITA
Other - Last Name:GRAZIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:57 SANDRA RD
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11937-1762
Mailing Address - Country:US
Mailing Address - Phone:516-526-9535
Mailing Address - Fax:
Practice Address - Street 1:538 BROADHOLLOW RD
Practice Address - Street 2:SUITE 202
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3676
Practice Address - Country:US
Practice Address - Phone:631-385-7780
Practice Address - Fax:631-385-7795
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker