Provider Demographics
NPI:1679273676
Name:CL MEDICINE PLLC
Entity Type:Organization
Organization Name:CL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARUVASTRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-389-9871
Mailing Address - Street 1:200 PARK AVE S STE 1118B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-1537
Mailing Address - Country:US
Mailing Address - Phone:646-389-4780
Mailing Address - Fax:
Practice Address - Street 1:200 PARK AVE S STE 1118B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1537
Practice Address - Country:US
Practice Address - Phone:646-389-4780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty