Provider Demographics
NPI:1740295179
Name:LA CHARME LLC
Entity type:Organization
Organization Name:LA CHARME LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:A
Authorized Official - Last Name:COELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-623-5031
Mailing Address - Street 1:58 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4733
Mailing Address - Country:US
Mailing Address - Phone:800-708-9312
Mailing Address - Fax:718-923-0351
Practice Address - Street 1:58 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-4733
Practice Address - Country:US
Practice Address - Phone:800-708-9312
Practice Address - Fax:718-923-0351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier