Healthcare Provider Details

I. General information

NPI: 1659332864
Provider Name (Legal Business Name): CHARLES A GROPPER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4487 3RD AVE FL 2
BRONX NY
10457-1526
US

IV. Provider business mailing address

4487 3RD AVE FL 2
BRONX NY
10457-1526
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-5085
  • Fax: 718-960-6465
Mailing address:
  • Phone: 718-960-5085
  • Fax: 718-960-6465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number175302
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: