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General NPI Number Information
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NPI Number | 1861876328
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Entity Type | Organization
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Legal Business Name | CHRISTAL D CHARBONNET, DPM P.C.
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Dates
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Enumeration Date | 07/15/2015
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Last Update Date | 07/15/2015
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Provider Practice Location Address
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Address Line | 4243 RICHMOND AVE 1ST FLOOR
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City | STATEN ISLAND
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State | NY
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Zip | 10312-6221
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Country | US
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Telephone | 504-460-0987
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 15616
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City | NEW ORLEANS
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State | LA
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Zip | 70175-5616
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Country | US
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Telephone | 504-460-0987
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Fax |
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | DR. CHRISTAL CHARBONNET
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Credential | DPM
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Telephone | 504-460-0987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | N006465
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License Number State | NY
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