Provider Demographics
NPI:1700052750
Name:CHARLES E CONNANT MD PA
Entity Type:Organization
Organization Name:CHARLES E CONNANT MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:CONNANT
Authorized Official - Suffix:
Authorized Official - Credentials:PA MEDICAL DOCTOR
Authorized Official - Phone:201-653-1122
Mailing Address - Street 1:10 HURON AVENUE
Mailing Address - Street 2:APT 1D
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306
Mailing Address - Country:US
Mailing Address - Phone:201-653-1122
Mailing Address - Fax:201-653-4640
Practice Address - Street 1:10 HURON AVENUE
Practice Address - Street 2:APT 1D
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306
Practice Address - Country:US
Practice Address - Phone:201-653-1122
Practice Address - Fax:201-653-4640
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLES E CONNANT MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA01867600207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty