Provider Demographics
NPI:1134109994
Name:HINZ, CHARLES J (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:HINZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6108 LINDEN STREET
Mailing Address - Street 2:
Mailing Address - City:RINDGWEOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385
Mailing Address - Country:US
Mailing Address - Phone:718-384-1834
Mailing Address - Fax:718-384-4736
Practice Address - Street 1:6108 LINDEN ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-3323
Practice Address - Country:US
Practice Address - Phone:718-384-1834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226503207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02364125Medicaid
NYH90503Medicare ID - Type Unspecified
NY5199B1Medicare ID - Type UnspecifiedEMPIRE