Provider Demographics
NPI:1881713634
Name:CHARLES, PAMELA ANN (DC, DACNB)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:ANN
Last Name:CHARLES
Suffix:
Gender:F
Credentials:DC, DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1085 PARK AVENUE
Mailing Address - Street 2:SUITE 1-E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1180
Mailing Address - Country:US
Mailing Address - Phone:212-348-7876
Mailing Address - Fax:212-360-7974
Practice Address - Street 1:1085 PARK AVENUE
Practice Address - Street 2:SUITE 1-E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1180
Practice Address - Country:US
Practice Address - Phone:212-348-7876
Practice Address - Fax:212-360-7974
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009333-1111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY113641347OtherEIN
NY113641347OtherEIN
NYX5D152Medicare ID - Type UnspecifiedPROVIDER