Healthcare Provider Details

I. General information

NPI: 1518413038
Provider Name (Legal Business Name): CARMELLE SUZELINE CHARLESTON APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RIVERFRONT PLZ STE 300
NEWARK NJ
07102-5412
US

IV. Provider business mailing address

1 DIAMOND HILL RD
BERKELEY HEIGHTS NJ
07922-2104
US

V. Phone/Fax

Practice location:
  • Phone: 201-273-7047
  • Fax: 855-998-4358
Mailing address:
  • Phone: 908-273-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00651300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: