Provider Demographics
NPI:1245230804
Name:SHIOLENO, CHARLES A (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:SHIOLENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 TEMPE WICK RD
Mailing Address - Street 2:
Mailing Address - City:MENDHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07945-1814
Mailing Address - Country:US
Mailing Address - Phone:973-543-2288
Mailing Address - Fax:973-543-0637
Practice Address - Street 1:8 TEMPE WICK RD
Practice Address - Street 2:
Practice Address - City:MENDHAM
Practice Address - State:NJ
Practice Address - Zip Code:07945
Practice Address - Country:US
Practice Address - Phone:973-543-2288
Practice Address - Fax:973-543-0637
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04049400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2242401Medicaid
NJ520255Medicare ID - Type Unspecified
NJC53987Medicare UPIN