Healthcare Provider Details

I. General information

NPI: 1013941186
Provider Name (Legal Business Name): CHARLES JOSEPH MULLIN RPA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DAVIS AVE AT E POST RD
WHITE PLAINS NY
10601-4615
US

IV. Provider business mailing address

145 ORCHARD ST
WHITE PLAINS NY
10604-1407
US

V. Phone/Fax

Practice location:
  • Phone: 914-681-1158
  • Fax: 914-681-2912
Mailing address:
  • Phone: 914-761-5640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number002833
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: