| Doctor Name: | DR. CHARLES POUPONNEAU |
| NPI Number: | 1023280740 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 187369 |
| Business Practice Address: | 147-20 Archer Avenue Jamaica, NY - 11435 |
| Business Phone Number: | 7182911888 |
| Business Fax Number: | 7182910557 |
| Mailing Address: | 147-20 Archer Avenue, JAMAICA |
| State: | NY |
| Postal Code: | 11435 |
| Phone Number: | 7182911888 |
| Fax Number: | 7182910557 |
| NPI Enumeration Date: | 04/02/2008 |
| NPI Last Update Date: | 04/02/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207QA0401X |
| License Number: | 187369 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Family Medicine |
| Taxonomy Specialization: | Addiction Medicine |
| Taxonomy Definition: | A family medicine physician who specializes in the diagnosis and treatment of addictions. |