Provider Demographics
NPI:1194040378
Name:NOOROLLAH, CHARLOTTE S (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:S
Last Name:NOOROLLAH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E 87TH ST APT 12C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1128
Mailing Address - Country:US
Mailing Address - Phone:718-869-7000
Mailing Address - Fax:
Practice Address - Street 1:87 BARNYARD LN
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2808
Practice Address - Country:US
Practice Address - Phone:718-869-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-31
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250554207N00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology