Healthcare Provider Details

I. General information

NPI: 1295294189
Provider Name (Legal Business Name): CHARLES JOHN PUZA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 5TH AVE
NEW YORK NY
10003-0068
US

IV. Provider business mailing address

500 W 23RD ST APT 7I
NEW YORK NY
10011-0055
US

V. Phone/Fax

Practice location:
  • Phone: 212-533-8888
  • Fax:
Mailing address:
  • Phone: 570-575-3625
  • Fax: 212-673-5185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number322183
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: