Healthcare Provider Details

I. General information

NPI: 1073599700
Provider Name (Legal Business Name): CHARLES CHOY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 MASON AVE
STATEN ISLAND NY
10305-3408
US

IV. Provider business mailing address

1 EDGEWATER ST SUITE 723
STATEN ISLAND NY
10305-4900
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-6398
  • Fax: 718-226-1247
Mailing address:
  • Phone: 718-226-1013
  • Fax: 718-226-1039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number227182
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: