Provider Demographics
NPI:1811721277
Name:CHARLOT-CHATELAIN, JESULA
Entity type:Individual
Prefix:
First Name:JESULA
Middle Name:
Last Name:CHARLOT-CHATELAIN
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 1:630 COUNTY ROUTE 93 # 630
Mailing Address - Street 2:
Mailing Address - City:SLATE HILL
Mailing Address - State:NY
Mailing Address - Zip Code:10973-4107
Mailing Address - Country:US
Mailing Address - Phone:845-598-9369
Mailing Address - Fax:
Practice Address - Street 1:630 COUNTY ROUTE 93 # 630
Practice Address - Street 2:
Practice Address - City:SLATE HILL
Practice Address - State:NY
Practice Address - Zip Code:10973-4107
Practice Address - Country:US
Practice Address - Phone:845-598-9369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLLW7274343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)