Provider Demographics
NPI:1942427836
Name:CHARUK, JOHN MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:CHARUK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 WHITEHORSE MERCERVILLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1953
Mailing Address - Country:US
Mailing Address - Phone:609-586-4591
Mailing Address - Fax:609-588-8688
Practice Address - Street 1:2312 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-1953
Practice Address - Country:US
Practice Address - Phone:609-586-4591
Practice Address - Fax:609-588-8688
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00112400103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical