Provider Demographics
NPI:1871747162
Name:ERENSEN, CHRISTINE GENISE
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:GENISE
Last Name:ERENSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:ANN
Other - Last Name:GENISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 MACARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:OLD GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06870-1219
Mailing Address - Country:US
Mailing Address - Phone:203-536-3341
Mailing Address - Fax:203-661-4990
Practice Address - Street 1:30 MACARTHUR DR
Practice Address - Street 2:
Practice Address - City:OLD GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06870-1219
Practice Address - Country:US
Practice Address - Phone:203-536-3341
Practice Address - Fax:203-661-4990
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016446-1172V00000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No172V00000XOther Service ProvidersCommunity Health Worker