Healthcare Provider Details

I. General information

NPI: 1265763254
Provider Name (Legal Business Name): PAMELA A CHARLES DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1085 PARK AVE SUITE 1-E
NEW YORK NY
10128-1168
US

IV. Provider business mailing address

1085 PARK AVE SUITE 1-E
NEW YORK NY
10128-1168
US

V. Phone/Fax

Practice location:
  • Phone: 212-348-7876
  • Fax: 212-360-7974
Mailing address:
  • Phone: 212-348-7876
  • Fax: 212-360-7974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number009333-1
License Number StateNY

VIII. Authorized Official

Name: DR. PAMELA ANN CHARLES
Title or Position: CEO
Credential: D.C.
Phone: 212-348-7876