Provider Demographics
NPI:1134964331
Name:CHARNAS, MARYLYNN
Entity type:Individual
Prefix:
First Name:MARYLYNN
Middle Name:
Last Name:CHARNAS
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 1:4 HAMPSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-8463
Mailing Address - Country:US
Mailing Address - Phone:917-912-0021
Mailing Address - Fax:
Practice Address - Street 1:4 HAMPSHIRE CT
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-8463
Practice Address - Country:US
Practice Address - Phone:917-912-0021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY$$$$$$$$$2080P0006X, 251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics