Provider Demographics
NPI:1841393121
Name:CIOLINO, CHARLES P (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:P
Last Name:CIOLINO
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 1:597 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-4503
Mailing Address - Country:US
Mailing Address - Phone:908-654-7399
Mailing Address - Fax:908-654-7422
Practice Address - Street 1:597 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-4503
Practice Address - Country:US
Practice Address - Phone:908-654-7399
Practice Address - Fax:908-654-7422
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA051805002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ414578AC3Medicare UPIN
NJ414578Medicare ID - Type Unspecified
NJ414578AC3Medicare PIN