Healthcare Provider Details

I. General information

NPI: 1255785440
Provider Name (Legal Business Name): CHARLIE GENE BUFFIE M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 03/22/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1283 YORK AVENUE 9TH FLOOR
NEW YORK NY
10065
US

IV. Provider business mailing address

505 EAST 70TH STREET
NEW YORK NY
10021
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-9663
  • Fax: 212-746-3609
Mailing address:
  • Phone: 212-746-9663
  • Fax: 212-746-3609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number306275
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: