Healthcare Provider Details

I. General information

NPI: 1417110958
Provider Name (Legal Business Name): CHARLENE SHERVONNE EMMANUEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4781 BROADWAY
NEW YORK NY
10034-4915
US

IV. Provider business mailing address

17 CARVER TER
YONKERS NY
10710-3705
US

V. Phone/Fax

Practice location:
  • Phone: 212-932-4200
  • Fax:
Mailing address:
  • Phone: 347-581-8219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number390200000X
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number144965
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number296793
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: