Healthcare Provider Details

I. General information

NPI: 1881693745
Provider Name (Legal Business Name): JACK CHARNEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FIRST AVE AT 16TH STREET
NEW YORK NY
10003
US

IV. Provider business mailing address

1900 HEMPSTEAD TPKE SUITE 500
EAST MEADOW NY
11554-1724
US

V. Phone/Fax

Practice location:
  • Phone: 212-420-2124
  • Fax: 212-844-1945
Mailing address:
  • Phone: 516-542-1090
  • Fax: 516-794-8165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number198453
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: