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General NPI Number Information
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NPI Number | 1134369705
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Entity Type | Organization
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Legal Business Name | CHARLES JIN MEDICAL PC
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Dates
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Enumeration Date | 02/23/2009
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Last Update Date | 02/23/2009
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Provider Practice Location Address
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Address Line | 8 DORSET RD
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City | GREAT NECK
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State | NY
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Zip | 11020-1702
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Country | US
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Telephone | 917-602-0065
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 220284
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City | GREAT NECK
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State | NY
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Zip | 11022-0284
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Country | US
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Telephone | 917-602-0065
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Fax |
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Authorized Official
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Title or Position | MD
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Name | CHARLES Y JIN
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Credential |
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Telephone | 917-602-0065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 222414
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License Number State | NY
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