Healthcare Provider Details

I. General information

NPI: 1871908749
Provider Name (Legal Business Name): PAMELA CHARNIN NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 04/04/2026
Certification Date: 04/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27005 76TH AVE
NEW HYDE PARK NY
11040-1496
US

IV. Provider business mailing address

36 OLD POST RD
EAST SETAUKET NY
11733-3742
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-7000
  • Fax:
Mailing address:
  • Phone: 516-388-3884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number338859-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: