Healthcare Provider Details

I. General information

NPI: 1366447203
Provider Name (Legal Business Name): CHARLES ANDREW ADAMS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE STE 501
HACKENSACK NJ
07601-1989
US

IV. Provider business mailing address

PO BOX 16149
RUMFORD RI
02916-0697
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-4777
  • Fax: 551-996-0800
Mailing address:
  • Phone: 401-453-9625
  • Fax: 401-435-7069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA06857900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number25MA06857900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: