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General NPI Number Information
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NPI Number | 1417110958
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Entity Type | Individual
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Provider Name | CHARLENE SHERVONNE EMMANUEL M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/03/2008
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Last Update Date | 05/24/2024
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Provider Practice Location Address
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Address Line | 4781 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10034-4915
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Country | US
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Telephone | 212-932-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 17 CARVER TER
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City | YONKERS
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State | NY
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Zip | 10710-3705
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Country | US
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Telephone | 347-581-8219
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 390200000X
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 144965
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 296793
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License Number State | NY
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