Provider Demographics
NPI:1508019829
Name:CHARLES E. GRANATIR, M.D.
Entity Type:Organization
Organization Name:CHARLES E. GRANATIR, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRANATIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-997-7667
Mailing Address - Street 1:586 KEARNY AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-2806
Mailing Address - Country:US
Mailing Address - Phone:201-997-7667
Mailing Address - Fax:201-997-3324
Practice Address - Street 1:586 KEARNY AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-2806
Practice Address - Country:US
Practice Address - Phone:201-997-7667
Practice Address - Fax:201-997-3324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA047062174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ518001OtherMEDICARE PROVIDER
NJC56640Medicare UPIN