Healthcare Provider Details

I. General information

NPI: 1821623364
Provider Name (Legal Business Name): CHARMAIN WATTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2020
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 W PALISADE AVE
ENGLEWOOD NJ
07631-2634
US

IV. Provider business mailing address

8B NIAGARA ST
DUMONT NJ
07628-3406
US

V. Phone/Fax

Practice location:
  • Phone: 201-567-0500
  • Fax:
Mailing address:
  • Phone: 201-851-1103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: