Provider Demographics
NPI:1427366095
Name:CHARLES PERICLES, CLAUDE ALINE (NP)
Entity Type:Individual
Prefix:
First Name:CLAUDE
Middle Name:ALINE
Last Name:CHARLES PERICLES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 BROADWAY
Mailing Address - Street 2:DEPARTMENT OF MANGED CARE ROOM 2B-230
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236
Mailing Address - Country:US
Mailing Address - Phone:718-630-3220
Mailing Address - Fax:718-630-3122
Practice Address - Street 1:100 NORTH PORTLAND AVENUE
Practice Address - Street 2:DEPARTMENT OF MEDICINE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205
Practice Address - Country:US
Practice Address - Phone:718-260-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333819-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily