Healthcare Provider Details

I. General information

NPI: 1316324676
Provider Name (Legal Business Name): MARY-BETH CHARNO RN, ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 BROADWAY
KINGSTON NY
12401-5150
US

IV. Provider business mailing address

4670 ATWOOD RD
STONE RIDGE NY
12484-5257
US

V. Phone/Fax

Practice location:
  • Phone: 516-524-2549
  • Fax: 516-717-1376
Mailing address:
  • Phone: 516-524-2649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number580618
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number307390
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: