Provider Demographics
NPI:1285331371
Name:CELANO, CHARLES (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:CELANO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:583 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5052
Mailing Address - Country:US
Mailing Address - Phone:516-799-3200
Mailing Address - Fax:
Practice Address - Street 1:583 BROADWAY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5052
Practice Address - Country:US
Practice Address - Phone:516-799-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013696111N00000X
NYX013696-01111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor