Provider Demographics
NPI:1750368486
Name:SPATZ, CHARLES R (DPM)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:R
Last Name:SPATZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 HAZLET AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1600
Mailing Address - Country:US
Mailing Address - Phone:732-847-3050
Mailing Address - Fax:732-212-9338
Practice Address - Street 1:80 HAZLET AVE STE 6
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730
Practice Address - Country:US
Practice Address - Phone:732-847-3050
Practice Address - Fax:732-212-9338
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00149300213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0916005Medicaid
1231720001OtherNSC
NJ416427Medicare PIN
NJT51178Medicare UPIN