Provider Demographics
NPI:1578859195
Name:CHARLES J KRONENGOLD, M.D., P.A.
Entity Type:Organization
Organization Name:CHARLES J KRONENGOLD, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRONENGOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-992-5005
Mailing Address - Street 1:22 OLD SHORT HILLS RD STE 111
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5605
Mailing Address - Country:US
Mailing Address - Phone:973-992-5005
Mailing Address - Fax:973-992-5024
Practice Address - Street 1:22 OLD SHORT HILLS RD STE 111
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5605
Practice Address - Country:US
Practice Address - Phone:973-992-5005
Practice Address - Fax:973-992-5024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02885900156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Single Specialty