Provider Demographics
NPI:1992957161
Name:ZIC, CHRISTINE (MSPT)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:ZIC
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 E 12TH ST
Mailing Address - Street 2:APT 4E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-7221
Mailing Address - Country:US
Mailing Address - Phone:212-997-7490
Mailing Address - Fax:
Practice Address - Street 1:230 W 38TH ST
Practice Address - Street 2:18TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-5803
Practice Address - Country:US
Practice Address - Phone:212-997-7490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-18
Last Update Date:2008-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025230-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY025230-1OtherPHYSICAL THERAPY LICENSE