Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 187369 | NY |
NPI | 1023280740 |
---|---|
Provider Name | Dr. Charles Pouponneau |
First Address | Jamaica, NY 11435 |
Second Address | Jamaica, NY 11435 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2008 |
Last Update Date | 02/04/2008 |