Provider Demographics
NPI:1649382136
Name:BACALL, CHARLES J (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:BACALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1203
Mailing Address - Country:US
Mailing Address - Phone:212-289-4500
Mailing Address - Fax:212-289-6793
Practice Address - Street 1:1126 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1203
Practice Address - Country:US
Practice Address - Phone:212-289-4500
Practice Address - Fax:212-289-6793
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129470207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
09A321Medicare ID - Type Unspecified
NYA99325Medicare UPIN
A99325Medicare UPIN