Provider Demographics
NPI:1609355882
Name:ROBINSON, CHARLES JR
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:ROBINSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 GLENN WILD RD
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:12789
Mailing Address - Country:US
Mailing Address - Phone:845-866-3229
Mailing Address - Fax:
Practice Address - Street 1:1220 GLENN WILD RD
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:NY
Practice Address - Zip Code:12789
Practice Address - Country:US
Practice Address - Phone:845-866-3229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)