Healthcare Provider Details

I. General information

NPI: 1861876328
Provider Name (Legal Business Name): CHRISTAL D CHARBONNET, DPM P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4243 RICHMOND AVE 1ST FLOOR
STATEN ISLAND NY
10312-6221
US

IV. Provider business mailing address

PO BOX 15616
NEW ORLEANS LA
70175-5616
US

V. Phone/Fax

Practice location:
  • Phone: 504-460-0987
  • Fax:
Mailing address:
  • Phone: 504-460-0987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN006465
License Number StateNY

VIII. Authorized Official

Name: DR. CHRISTAL CHARBONNET
Title or Position: PROVIDER/OWNER
Credential: DPM
Phone: 504-460-0987