Provider Demographics
NPI:1417996901
Name:CHANDLER, CHARLES (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 BAY ST
Mailing Address - Street 2:SUITE 915
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-2900
Mailing Address - Country:US
Mailing Address - Phone:973-986-4013
Mailing Address - Fax:
Practice Address - Street 1:150 BAY ST
Practice Address - Street 2:SUITE 915
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-2900
Practice Address - Country:US
Practice Address - Phone:973-986-4013
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMP00056300363AM0700X
NY006115-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJQ44339Medicare UPIN