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General NPI Number Information
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NPI Number | 1922334507
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Entity Type | Individual
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Provider Name | CHARLES NUTTALL M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/02/2009
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Last Update Date | 11/02/2009
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Provider Practice Location Address
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Address Line | 352 7TH AVE SUITE 808
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City | NEW YORK
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State | NY
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Zip | 10001-5012
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Country | US
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Telephone | 212-239-8042
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Fax | 212-239-8043
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Provider Business Mailing Address
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Address Line | 169 E 69TH ST SUITE 2A
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City | NEW YORK
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State | NY
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Zip | 10021-5163
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Country | US
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Telephone | 917-593-2458
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Fax | 212-249-1919
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 176345
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License Number State | NY
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