Provider Demographics
NPI:1902043029
Name:DR. CHARLES KORROL
Entity Type:Organization
Organization Name:DR. CHARLES KORROL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:KORROL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-549-3888
Mailing Address - Street 1:775 PARK AVE
Mailing Address - Street 2:SUITE 2009
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3976
Mailing Address - Country:US
Mailing Address - Phone:631-549-3888
Mailing Address - Fax:631-549-0243
Practice Address - Street 1:775 PARK AVE
Practice Address - Street 2:SUITE 2009
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3976
Practice Address - Country:US
Practice Address - Phone:631-549-3888
Practice Address - Fax:631-549-0243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0956612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY382591OtherMEDICARE P10
NY382591OtherMEDICARE P10