Healthcare Provider Details

I. General information

NPI: 1689961005
Provider Name (Legal Business Name): CHARLES SOLTNER JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

773 E ROUTE 70 STE E125
MARLTON NJ
08053-2341
US

IV. Provider business mailing address

773 E ROUTE 70 STE E125
MARLTON NJ
08053-2341
US

V. Phone/Fax

Practice location:
  • Phone: 856-988-7999
  • Fax:
Mailing address:
  • Phone: 856-988-7999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberC46657
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: