Provider Demographics
NPI:1043541329
Name:CHARLES, FRITZ M
Entity type:Individual
Prefix:MR
First Name:FRITZ
Middle Name:M
Last Name:CHARLES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:FRITZ
Other - Middle Name:M
Other - Last Name:CHARLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:6864960
Mailing Address - Street 1:20809 100TH AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-1020
Mailing Address - Country:US
Mailing Address - Phone:718-776-4808
Mailing Address - Fax:718-776-4808
Practice Address - Street 1:20809 100TH AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11429-1020
Practice Address - Country:US
Practice Address - Phone:718-776-4808
Practice Address - Fax:718-776-4808
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001647-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist