Provider Demographics
NPI:1891753604
Name:DAKNIS, CHARLES B (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:B
Last Name:DAKNIS
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 1:1967 RTE 34 STE 102
Mailing Address - Street 2:
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-9738
Mailing Address - Country:US
Mailing Address - Phone:732-345-1180
Mailing Address - Fax:732-530-4476
Practice Address - Street 1:1967 RTE 34 STE 102
Practice Address - Street 2:
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719-9738
Practice Address - Country:US
Practice Address - Phone:732-345-1180
Practice Address - Fax:732-530-4476
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06816000207LP2900X
NJMA 68160174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG25373Medicare UPIN
NJCR019678Medicare ID - Type Unspecified