Provider Demographics
NPI:1417061854
Name:MARCHESE, CHARLES G (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:G
Last Name:MARCHESE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 AVENUE U
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-3740
Mailing Address - Country:US
Mailing Address - Phone:718-996-8420
Mailing Address - Fax:718-714-6787
Practice Address - Street 1:145 ROUTE 33
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8355
Practice Address - Country:US
Practice Address - Phone:328-450-1007
Practice Address - Fax:732-845-1008
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00202500213E00000X
NYN004476213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7223200Medicaid
NY01127577Medicaid
NY480026837OtherRAILROAD MEDICARE
NYP4975XPZT1Medicare PIN
NYT81560Medicare UPIN