1811950850 NPI number — DR. ANJU CHARALEL M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811950850 NPI number — DR. ANJU CHARALEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHARALEL
Provider First Name:
ANJU
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VARGHESE
Provider Other First Name:
ANJU
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1811950850
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 483
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10956-0483
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-825-8167
Provider Business Mailing Address Fax Number:
845-290-6200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 SQUADRON BLVD
Provider Second Line Business Practice Location Address:
STE 345
Provider Business Practice Location Address City Name:
NEW CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-825-8167
Provider Business Practice Location Address Fax Number:
845-290-6200
Provider Enumeration Date:
04/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , with the licence number:  231379 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 132749853 . This is a "TAX ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02780707 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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