Provider Demographics
NPI:1275802902
Name:RICHARD P CHARMOY DMD LLC
Entity Type:Organization
Organization Name:RICHARD P CHARMOY DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:CHARMOY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:908-722-9222
Mailing Address - Street 1:78 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876
Mailing Address - Country:US
Mailing Address - Phone:908-722-9222
Mailing Address - Fax:908-231-0334
Practice Address - Street 1:78 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876
Practice Address - Country:US
Practice Address - Phone:908-722-9222
Practice Address - Fax:908-231-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-27
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D101516000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6664040001Medicare NSC