Provider Demographics
NPI:1295294189
Name:PUZA, CHARLES JOHN
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:JOHN
Last Name:PUZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W 23RD ST APT 7I
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-0055
Mailing Address - Country:US
Mailing Address - Phone:570-575-3625
Mailing Address - Fax:212-673-5185
Practice Address - Street 1:119 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-0068
Practice Address - Country:US
Practice Address - Phone:212-533-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY322183207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology