Provider Demographics
NPI:1457845083
Name:FOX, CHARLENE (RD, CDE)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:MS
Other - First Name:CHARLENE
Other - Middle Name:
Other - Last Name:BRECHISCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:STONY BROOK CHILDREN'S HOSPITAL
Mailing Address - Street 2:100 NICOLLS ROAD, T-11, ROOM 060
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8111
Mailing Address - Country:US
Mailing Address - Phone:631-444-7885
Mailing Address - Fax:631-444-8968
Practice Address - Street 1:37 RESEARCH WAY
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3465
Practice Address - Country:US
Practice Address - Phone:631-444-7885
Practice Address - Fax:631-444-8968
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY929486133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered