Individual
CHARLES JENKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
106 HAMMOND RD, THIELLS, NY 10984-1201
(845) 942-3522
Mailing address
81 PINE DR, STONY POINT, NY 10980-2515
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22
RESTORATIVE SERVICE PROVI
NY
Enumeration date
07/07/2006
Last updated
07/08/2007
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