Healthcare Provider Details

I. General information

NPI: 1073107314
Provider Name (Legal Business Name): CHARLES H. THORNE MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 PARK AVE APT 1A
NEW YORK NY
10021-2770
US

IV. Provider business mailing address

812 PARK AVE APT 1A
NEW YORK NY
10021-2770
US

V. Phone/Fax

Practice location:
  • Phone: 212-794-0044
  • Fax: 212-772-1326
Mailing address:
  • Phone: 212-794-0044
  • Fax: 212-772-1326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHARLES H THORNE
Title or Position: OWNER
Credential: MD
Phone: 212-794-0044