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General NPI Number Information
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NPI Number | 1902043029
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Entity Type | Organization
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Legal Business Name | DR. CHARLES KORROL
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Dates
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Enumeration Date | 01/12/2009
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Last Update Date | 01/12/2009
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Provider Practice Location Address
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Address Line | 775 PARK AVE SUITE 2009
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City | HUNTINGTON
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State | NY
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Zip | 11743-3976
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Country | US
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Telephone | 631-549-3888
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Fax | 631-549-0243
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Provider Business Mailing Address
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Address Line | 775 PARK AVE SUITE 2009
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City | HUNTINGTON
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State | NY
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Zip | 11743-3976
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Country | US
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Telephone | 631-549-3888
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Fax | 631-549-0243
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLES R. KORROL
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Credential | D.O.
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Telephone | 631-549-3888
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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 | 095661
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License Number State | NY
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