MEDICARE: ST CHARLES MEDICAL CONSULT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1427673755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST CHARLES MEDICAL CONSULT LLC

Provider Business Mailing Address
First Line	:	691 TREMONT CT
Second Line	:
City	:	ORANGE
State	:	NJ
Zip	:	07050-3009
Country	:	US
Telephone Number	:	862-215-5089
Fax Number	:

Provider Business Practice Location Address
First Line	:	691 TREMONT CT
Second Line	:
City	:	ORANGE
State	:	NJ
Zip	:	07050-3009
Country	:	US
Telephone Number	:	862-215-5089
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	APHIE AMAMS
Credential	:
Telephone Number	:	862-215-5089

Provider Enumeration Date	:	06/12/2020
Last Update Date	:	03/18/2026

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Directions to “ST CHARLES MEDICAL CONSULT LLC ” Practice Location

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