Provider Demographics
NPI:1629305123
Name:JEAN-CHARLES, MARTINE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARTINE
Middle Name:
Last Name:JEAN-CHARLES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 OLD TOWN RD
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-1108
Mailing Address - Country:US
Mailing Address - Phone:631-846-8592
Mailing Address - Fax:
Practice Address - Street 1:941 OLD TOWN RD
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-1108
Practice Address - Country:US
Practice Address - Phone:631-846-8592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4303151163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult