Provider Demographics
NPI:1770364671
Name:JEUNE, CHARLY (N/A)
Entity type:Individual
Prefix:
First Name:CHARLY
Middle Name:
Last Name:JEUNE
Suffix:
Gender:M
Credentials:N/A
Other - Prefix:
Other - First Name:CHARLY
Other - Middle Name:
Other - Last Name:JEUNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:GROUPHOMECARE
Mailing Address - Street 1:927 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6943
Mailing Address - Country:US
Mailing Address - Phone:908-327-7619
Mailing Address - Fax:
Practice Address - Street 1:927 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6943
Practice Address - Country:US
Practice Address - Phone:908-327-7619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion