Provider Demographics
NPI:1366602070
Name:PIRRO, CHARLES NICHOLAS (NP)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:NICHOLAS
Last Name:PIRRO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5821 ROUTE 80
Mailing Address - Street 2:
Mailing Address - City:TULLY
Mailing Address - State:NY
Mailing Address - Zip Code:13159
Mailing Address - Country:US
Mailing Address - Phone:315-696-6114
Mailing Address - Fax:315-696-8509
Practice Address - Street 1:5821 ROUTE 80
Practice Address - Street 2:
Practice Address - City:TULLY
Practice Address - State:NY
Practice Address - Zip Code:13159
Practice Address - Country:US
Practice Address - Phone:315-696-6114
Practice Address - Fax:315-696-8509
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333524363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02289581Medicaid
385865OtherANCC BOARD CERTIFICATION
NY516186OtherREGISTERED PROFESSIONAL NURSE LICENSE
NYF333524OtherFAMILY NURSE PRACTITIONER LICENSE
NYF333524OtherFAMILY NURSE PRACTITIONER LICENSE