Healthcare Provider Details

I. General information

NPI: 1962659953
Provider Name (Legal Business Name): CHARLES EDWARD FLORES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 WHITEHORSE MERCERVILLE RD
HAMILTON NJ
08619-3838
US

IV. Provider business mailing address

2 HART CT
TITUSVILLE NJ
08560-1519
US

V. Phone/Fax

Practice location:
  • Phone: 609-581-1700
  • Fax: 609-581-9957
Mailing address:
  • Phone: 609-468-4900
  • Fax: 609-527-3009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number25MA08329600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA08329600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: