Provider Demographics
NPI:1477617348
Name:FILLEBROWN, CHARLES M (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:M
Last Name:FILLEBROWN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3630 HILL BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:JEFFERSON VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10535-1502
Mailing Address - Country:US
Mailing Address - Phone:914-962-5571
Mailing Address - Fax:914-962-5574
Practice Address - Street 1:3630 HILL BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:JEFFERSON VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10535-1502
Practice Address - Country:US
Practice Address - Phone:914-962-5571
Practice Address - Fax:914-962-5574
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYN002571213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT50826Medicare UPIN
NYPFW061Medicare ID - Type Unspecified