Provider Demographics
NPI:1053855536
Name:DALY, CHRISTINE B
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:B
Last Name:DALY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:ELIZABETH
Other - Last Name:BRODERICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:758 WILDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-1151
Mailing Address - Country:US
Mailing Address - Phone:914-245-6836
Mailing Address - Fax:
Practice Address - Street 1:758 WILDWOOD CT
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-1151
Practice Address - Country:US
Practice Address - Phone:914-245-6836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-18
Last Update Date:2016-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor