Provider Demographics
NPI:1568678555
Name:BURN, CHARLENE HARGROVE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:HARGROVE
Last Name:BURN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 RIVERVIEW TERRACE
Mailing Address - Street 2:
Mailing Address - City:UPPER SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-2006
Mailing Address - Country:US
Mailing Address - Phone:201-760-9709
Mailing Address - Fax:201-760-9402
Practice Address - Street 1:49 RIVERVIEW TERRACE
Practice Address - Street 2:
Practice Address - City:UPPER SADDLE RIVER
Practice Address - State:NJ
Practice Address - Zip Code:07458-2006
Practice Address - Country:US
Practice Address - Phone:201-760-9709
Practice Address - Fax:201-760-9402
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA023370002084P0800X
CT0449962084P0800X
NY233702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
D06475Medicare UPIN