Provider Demographics
NPI:1750652509
Name:CHARLES, FRITZA R
Entity Type:Individual
Prefix:MS
First Name:FRITZA
Middle Name:R
Last Name:CHARLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:WHEATLEY HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11798-2128
Mailing Address - Country:US
Mailing Address - Phone:631-920-2229
Mailing Address - Fax:631-920-2229
Practice Address - Street 1:188 MAIN AVE
Practice Address - Street 2:
Practice Address - City:WHEATLEY HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11798-2128
Practice Address - Country:US
Practice Address - Phone:631-920-2229
Practice Address - Fax:631-920-2229
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY548398-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse