MEDICARE: KENTIA JEAN-CHARLES

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	111N00000X	Chiropractor	X011421	NY

General Provider Information

NPI Number	:	1841389079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENTIA JEAN-CHARLES

Provider Business Mailing Address
First Line	:	260-03 UNION TPKE
Second Line	:
City	:	GLEN OAKS
State	:	NY
Zip	:	11004-1345
Country	:	US
Telephone Number	:	718-360-9603
Fax Number	:	718-502-8332

Provider Business Practice Location Address
First Line	:	26003 UNION TPKE
Second Line	:
City	:	GLEN OAKS
State	:	NY
Zip	:	11004-1345
Country	:	US
Telephone Number	:	718-360-9603
Fax Number	:	718-502-8332

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	08/31/2015

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Directions to “ KENTIA JEAN-CHARLES ” Practice Location

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