Provider Demographics
NPI:1679648596
Name:KRONENGOLD, CHARLES J (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:KRONENGOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02885900207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC55156Medicare UPIN
NJ451023Medicare PIN