MEDICARE: JEAN CLAUDE CHARLES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	199884	NY
2	174400000X	Specialist	199884	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	199884	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1790782969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN CLAUDE CHARLES MD

Provider Business Mailing Address
First Line	:	12930 135TH ST
Second Line	:
City	:	SOUTH OZONE PARK
State	:	NY
Zip	:	11420-3542
Country	:	US
Telephone Number	:	347-522-7547
Fax Number	:	347-789-5533

Provider Business Practice Location Address
First Line	:	68 BELMONT AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11212-6705
Country	:	US
Telephone Number	:	718-484-8056
Fax Number	:	718-484-8325

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2005
Last Update Date	:	04/09/2021

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