Provider Demographics
NPI:1386786788
Name:CHAMPANERI, CHARU (MD,FAAP)
Entity type:Individual
Prefix:DR
First Name:CHARU
Middle Name:
Last Name:CHAMPANERI
Suffix:
Gender:F
Credentials:MD,FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6860 108TH ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2973
Mailing Address - Country:US
Mailing Address - Phone:718-793-4003
Mailing Address - Fax:
Practice Address - Street 1:6860 108TH ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2973
Practice Address - Country:US
Practice Address - Phone:718-793-4003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162530208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03871932Medicaid