Individual
CHARLES R DENNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 MEDFORD AVE, SUITE E, PATCHOGUE, NY 11772-1229
(631) 687-4190
(631) 687-4198
Mailing address
PO BOX 465, LAUREL, NY 11948-0465
(631) 687-4190
(631) 687-4198
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
126943-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00376701
—
NY
Enumeration date
07/04/2006
Last updated
02/03/2014
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