Healthcare Provider Details

I. General information

NPI: 1437156882
Provider Name (Legal Business Name): CHARLES J MAROTTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 RIDGEDALE AVE
CEDAR KNOLLS NJ
07927-1313
US

IV. Provider business mailing address

65 RIDGEDALE AVE
CEDAR KNOLLS NJ
07927-1313
US

V. Phone/Fax

Practice location:
  • Phone: 973-401-1100
  • Fax: 973-401-1201
Mailing address:
  • Phone: 973-401-1100
  • Fax: 973-401-1201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA4313800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: