Provider Demographics
NPI:1710554621
Name:CHARPENTIER, JACOB ORESTES (MSAT, ATC)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:ORESTES
Last Name:CHARPENTIER
Suffix:
Gender:M
Credentials:MSAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 OAKLAND AVE # A
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-7911
Mailing Address - Country:US
Mailing Address - Phone:973-856-0531
Mailing Address - Fax:
Practice Address - Street 1:32 OAKLAND AVE # A
Practice Address - Street 2:
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7911
Practice Address - Country:US
Practice Address - Phone:973-856-0531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2255A2300X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer