Healthcare Provider Details

I. General information

NPI: 1366488611
Provider Name (Legal Business Name): CHARLES J PASSET DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6357 108TH ST
FOREST HILLS NY
11375-1607
US

IV. Provider business mailing address

6357 108TH ST
FOREST HILLS NY
11375-1607
US

V. Phone/Fax

Practice location:
  • Phone: 718-896-6369
  • Fax: 718-896-6159
Mailing address:
  • Phone: 718-896-6369
  • Fax: 718-896-6159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN003006
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: