Healthcare Provider Details

I. General information

NPI: 1356120612
Provider Name (Legal Business Name): AGLAE M CHARLOT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AGLAE CHARLOT MD

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 09/26/2023
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 E RIDGEWOOD AVE
PARAMUS NJ
07652-4819
US

IV. Provider business mailing address

213 E 26TH ST APT 1C
NEW YORK NY
10010-1955
US

V. Phone/Fax

Practice location:
  • Phone: 201-646-2940
  • Fax: 201-646-2950
Mailing address:
  • Phone: 646-279-4976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number25MA10520100
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: