Provider Demographics
NPI:1760644819
Name:WAJSZCZUK, CHARLES P (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:P
Last Name:WAJSZCZUK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHARLES
Other - Middle Name:P
Other - Last Name:WAJSZCZUK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:199 GRANDVIEW RD
Mailing Address - Street 2:SC-137
Mailing Address - City:SKILLMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08558-1311
Mailing Address - Country:US
Mailing Address - Phone:908-874-1450
Mailing Address - Fax:908-904-3864
Practice Address - Street 1:199 GRANDVIEW RD
Practice Address - Street 2:SC-137
Practice Address - City:SKILLMAN
Practice Address - State:NJ
Practice Address - Zip Code:08558-1311
Practice Address - Country:US
Practice Address - Phone:908-874-1450
Practice Address - Fax:908-904-3862
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03943800172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA03943800OtherMD