Doctor Name: | PATRICK CHARLES |
NPI Number: | 1295138782 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DO |
License Number: | 730351468 |
Business Practice Address: | 30 Prospect Ave Hackensack, NJ - 076011914 |
Business Phone Number: | 5519962331 |
Business Fax Number: | |
Mailing Address: | 5665 Kennedy Blvd, Apt 337 NORTH BERGEN |
State: | NJ |
Postal Code: | 070473223 |
Phone Number: | 5164281219 |
Fax Number: | |
NPI Enumeration Date: | 09/29/2014 |
NPI Last Update Date: | 09/29/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 730351468 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |