Provider Demographics
NPI:1548216237
Name:ALLEN, CHARLES J (OTR/L,CHT)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:J
Last Name:ALLEN
Suffix:
Gender:M
Credentials:OTR/L,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 AMBER CT
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-3107
Mailing Address - Country:US
Mailing Address - Phone:631-761-6996
Mailing Address - Fax:631-761-6997
Practice Address - Street 1:2108 JOSHUAS PATH
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4764
Practice Address - Country:US
Practice Address - Phone:631-761-6996
Practice Address - Fax:631-761-6997
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100117620Medicare PIN
NY7320220001Medicare NSC
NYA400117729Medicare PIN