Provider Demographics
NPI:1033452925
Name:CHUAYANA, CHARLOTTE MON
Entity Type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:MON
Last Name:CHUAYANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 LINDEN PL
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646-3002
Mailing Address - Country:US
Mailing Address - Phone:201-970-8407
Mailing Address - Fax:
Practice Address - Street 1:270 LINDEN PL
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07646-3002
Practice Address - Country:US
Practice Address - Phone:201-970-8407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00066100225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJW198340967OtherAETNA