Provider Demographics
NPI:1689930141
Name:EKSTEIN, CHARLES MARC (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MARC
Last Name:EKSTEIN
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 1:270-05 76TH AVE
Mailing Address - Street 2:DEPARTMENT OF ORTHOPEDICS
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040
Mailing Address - Country:US
Mailing Address - Phone:216-403-5142
Mailing Address - Fax:
Practice Address - Street 1:102 W 85TH ST
Practice Address - Street 2:APT 5F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-4405
Practice Address - Country:US
Practice Address - Phone:216-403-5142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY272010207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery