Provider Demographics
NPI:1689331886
Name:TAYLOR, CHARLENE J
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:J
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 LINCOLN PARK
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-2388
Mailing Address - Country:US
Mailing Address - Phone:973-623-0600
Mailing Address - Fax:
Practice Address - Street 1:103 LINCOLN PARK
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2388
Practice Address - Country:US
Practice Address - Phone:973-623-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist