Provider Demographics
NPI:1508831835
Name:GNASSI, CHARLES P (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:P
Last Name:GNASSI
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 1:104 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:ALLENHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07711-1209
Mailing Address - Country:US
Mailing Address - Phone:732-247-2422
Mailing Address - Fax:
Practice Address - Street 1:223 STATE HIGHWAY NO.18
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816
Practice Address - Country:US
Practice Address - Phone:732-247-2422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA018617002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC55486Medicare UPIN