Provider Demographics
NPI:1568668697
Name:MASCENIK, CHARLES EDWARD JR (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EDWARD
Last Name:MASCENIK
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 NEWARK AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2302
Mailing Address - Country:US
Mailing Address - Phone:201-420-1165
Mailing Address - Fax:201-420-6893
Practice Address - Street 1:590 NEWARK AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2302
Practice Address - Country:US
Practice Address - Phone:201-420-1165
Practice Address - Fax:201-420-6893
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMCO6174111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ083474Medicare ID - Type UnspecifiedMEDICARE