1760644819 NPI number — DR. CHARLES P WAJSZCZUK M.D.

Table of content: DR. CHARLES P WAJSZCZUK M.D. (NPI 1760644819)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760644819 NPI number — DR. CHARLES P WAJSZCZUK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WAJSZCZUK
Provider First Name:
CHARLES
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WAJSZCZUK
Provider Other First Name:
CHARLES
Provider Other Middle Name:
P
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1760644819
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
199 GRANDVIEW RD
Provider Second Line Business Mailing Address:
SC-137
Provider Business Mailing Address City Name:
SKILLMAN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08558-1311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-874-1450
Provider Business Mailing Address Fax Number:
908-904-3864

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
199 GRANDVIEW RD
Provider Second Line Business Practice Location Address:
SC-137
Provider Business Practice Location Address City Name:
SKILLMAN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08558-1311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-874-1450
Provider Business Practice Location Address Fax Number:
908-904-3862
Provider Enumeration Date:
06/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 172V00000X , with the licence number:  25MA03943800 , 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)

  • Identifier: 25MA03943800 . This is a "MD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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