Provider Demographics
NPI:1093465841
Name:WEIN, CHARLOTTE
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:WEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALTERNATE CHOICE
Other - Middle Name:
Other - Last Name:HOME CARE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:12601 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-2219
Mailing Address - Country:US
Mailing Address - Phone:347-975-2525
Mailing Address - Fax:
Practice Address - Street 1:12601 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-2219
Practice Address - Country:US
Practice Address - Phone:347-975-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9076L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health