Provider Demographics
NPI:1164036430
Name:PIAZZA, CHARLES JAMES (LMT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:JAMES
Last Name:PIAZZA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 W HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:BEACH HAVEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08008-6119
Mailing Address - Country:US
Mailing Address - Phone:732-456-4857
Mailing Address - Fax:
Practice Address - Street 1:112 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-2904
Practice Address - Country:US
Practice Address - Phone:732-456-4857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00593300225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist