Provider Demographics
NPI:1598760068
Name:BLATZ, CHARLES GEORGE (CRNA)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:GEORGE
Last Name:BLATZ
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34672
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07189-0001
Mailing Address - Country:US
Mailing Address - Phone:201-804-2800
Mailing Address - Fax:
Practice Address - Street 1:COOPER ANESTHESIA GROUP
Practice Address - Street 2:1 COOPER PLAZA, DEPT OF ANESTHESIA
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-2412
Practice Address - Country:US
Practice Address - Phone:856-342-2425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2007-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR10391300367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ062139Medicare ID - Type Unspecified