=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174839526
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARLENE GRACE FOSTER M.D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2010
-----------------------------------------------------
Last Update Date | 11/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4045 HEMPSTEAD TPKE
-----------------------------------------------------
City | BETHPAGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11714-5611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-731-7770
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 954 WOODFIELD RD
-----------------------------------------------------
City | WEST HEMPSTEAD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11552-4151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-678-0921
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 317303
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------