Provider Demographics
NPI:1992703847
Name:MORELLI, CHARLES (DPM)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:MORELLI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 E BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-4109
Mailing Address - Country:US
Mailing Address - Phone:914-835-6604
Mailing Address - Fax:914-835-6913
Practice Address - Street 1:910 E BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-4109
Practice Address - Country:US
Practice Address - Phone:914-835-6604
Practice Address - Fax:914-835-6913
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004812213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP08781OtherEMPIRE ID NUMBER
NYP672271OtherOXFORD ID NUMBER
NY1C5826OtherHEALTHNET ID NUMBER
NY01537026Medicaid
NY480023413OtherRAILROAD MEDICARE ID #
NYP08781OtherEMPIRE ID NUMBER
NYP672271OtherOXFORD ID NUMBER
NYU06475Medicare UPIN