Provider Demographics
NPI:1093983892
Name:CHARLES BALDUCCI,MD.PC
Entity Type:Organization
Organization Name:CHARLES BALDUCCI,MD.PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PC
Authorized Official - Phone:718-358-8888
Mailing Address - Street 1:38-25 PARSONS BLVD.
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5837
Mailing Address - Country:US
Mailing Address - Phone:718-358-8888
Mailing Address - Fax:
Practice Address - Street 1:38-25 PARSONS BLVD.
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5837
Practice Address - Country:US
Practice Address - Phone:718-358-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health