Provider Demographics
NPI:1689310534
Name:CHRNPDA
Entity Type:Organization
Organization Name:CHRNPDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MASCARENHAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-984-0520
Mailing Address - Street 1:1217 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-3138
Mailing Address - Country:US
Mailing Address - Phone:201-984-0520
Mailing Address - Fax:848-257-9207
Practice Address - Street 1:1217 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-3138
Practice Address - Country:US
Practice Address - Phone:201-984-0520
Practice Address - Fax:848-257-9207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty