Provider Demographics
NPI:1811950850
Name:CHARALEL, ANJU (MD)
Entity type:Individual
Prefix:DR
First Name:ANJU
Middle Name:
Last Name:CHARALEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANJU
Other - Middle Name:
Other - Last Name:VARGHESE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 483
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-0483
Mailing Address - Country:US
Mailing Address - Phone:845-825-8167
Mailing Address - Fax:845-290-6200
Practice Address - Street 1:20 SQUADRON BLVD
Practice Address - Street 2:STE 345
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956
Practice Address - Country:US
Practice Address - Phone:845-825-8167
Practice Address - Fax:845-290-6200
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231379207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY132749853OtherTAX ID #
NY02780707Medicaid
NY4287FZMedicare PIN
NY132749853OtherTAX ID #
NY02780707Medicaid