1700052750 NPI number — CHARLES E CONNANT MD PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700052750 NPI number — CHARLES E CONNANT MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLES E CONNANT MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700052750
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 HURON AVENUE
Provider Second Line Business Mailing Address:
APT 1D
Provider Business Mailing Address City Name:
JERSEY CITY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-653-1122
Provider Business Mailing Address Fax Number:
201-653-4640

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 HURON AVENUE
Provider Second Line Business Practice Location Address:
APT 1D
Provider Business Practice Location Address City Name:
JERSEY CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-653-1122
Provider Business Practice Location Address Fax Number:
201-653-4640
Provider Enumeration Date:
04/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CONNANT
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
201-653-1122

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  25MA01867600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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