Provider Demographics
NPI:1881684835
Name:PAOLINI, CHARLES M (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:M
Last Name:PAOLINI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 SEMINARY DRIVE
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430
Mailing Address - Country:US
Mailing Address - Phone:201-818-0991
Mailing Address - Fax:201-818-0994
Practice Address - Street 1:62 SEMINARY DRIVE
Practice Address - Street 2:
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430
Practice Address - Country:US
Practice Address - Phone:201-818-0991
Practice Address - Fax:201-818-0994
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00120100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP413689OtherOXFORD INSURANCE
T44892Medicare UPIN
NJ412135Medicare ID - Type Unspecified