Provider Demographics
NPI:1710961917
Name:CRANE, CHARLES J (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:CRANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1855
Mailing Address - Country:US
Mailing Address - Phone:973-763-2203
Mailing Address - Fax:973-762-9449
Practice Address - Street 1:71 2ND ST
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-1855
Practice Address - Country:US
Practice Address - Phone:973-763-2203
Practice Address - Fax:973-762-9449
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05335300207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6155103Medicaid
NJ6155103Medicaid
NJ769770BWRMedicare ID - Type Unspecified