Healthcare Provider Details

I. General information

NPI: 1790782969
Provider Name (Legal Business Name): JEAN CLAUDE CHARLES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2005
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 BELMONT AVE
BROOKLYN NY
11212-6705
US

IV. Provider business mailing address

12930 135TH ST
SOUTH OZONE PARK NY
11420-3542
US

V. Phone/Fax

Practice location:
  • Phone: 718-484-8056
  • Fax: 718-484-8325
Mailing address:
  • Phone: 347-522-7547
  • Fax: 347-789-5533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number199884
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number199884
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: