Provider Demographics
NPI:1336189356
Name:CHARKO, GREGORY PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:PETER
Last Name:CHARKO
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 1:975 LEHIGH AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7632
Mailing Address - Country:US
Mailing Address - Phone:908-686-1488
Mailing Address - Fax:908-687-7886
Practice Address - Street 1:975 LEHIGH AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-7632
Practice Address - Country:US
Practice Address - Phone:908-686-1488
Practice Address - Fax:908-687-7886
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA44836207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3390306Medicaid
NJ3390306Medicaid
NJE98177Medicare UPIN