Healthcare Provider Details

I. General information

NPI: 1881713634
Provider Name (Legal Business Name): PAMELA ANN CHARLES D.C., D.A.C.N.B.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1085 PARK AVENUE SUITE 1-E
NEW YORK NY
10128-1180
US

IV. Provider business mailing address

1085 PARK AVENUE SUITE 1-E
NEW YORK NY
10128-1180
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 NumberX009333-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: