Provider Demographics
NPI:1366488611
Name:PASSET, CHARLES J (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:PASSET
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:6357 108TH ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1607
Mailing Address - Country:US
Mailing Address - Phone:718-896-6369
Mailing Address - Fax:718-896-6159
Practice Address - Street 1:6357 108TH ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1607
Practice Address - Country:US
Practice Address - Phone:718-896-6369
Practice Address - Fax:718-896-6159
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYN003006213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00440524Medicaid
NY00440524Medicaid
NY37886AMedicare PIN