Provider Demographics
NPI:1336671429
Name:CHARNY, JACOB W (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:W
Last Name:CHARNY
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 1:258 BEN FRANKLIN HWY E
Mailing Address - Street 2:
Mailing Address - City:BIRDSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19508-8772
Mailing Address - Country:US
Mailing Address - Phone:610-957-6671
Mailing Address - Fax:877-437-7288
Practice Address - Street 1:8001 ROOSEVELT BLVD STE 307
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-3039
Practice Address - Country:US
Practice Address - Phone:267-731-1333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11108600207N00000X
390200000X
PAMD480936207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program