Individual
MR. KERLY CHARLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
400 SUNRISE HWY, AMITYVILLE, NY 11701-2508
(631) 264-4000
Mailing address
117 BROOKSIDE AVE, NORTH BABYLON, NY 11703-4922
(631) 363-4139
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
405438
NY
Other
Enumeration date
11/17/2023
Last updated
11/17/2023
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