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General NPI Number Information
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NPI Number | 1023908118
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Entity Type | Individual
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Provider Name | IRIDIOUS CHARLES HALLBACK JR.
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Gender | Male
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Dates
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Enumeration Date | 07/08/2025
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 3 CLERMONT AVE
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City | EWING
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State | NJ
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Zip | 08618-2615
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Country | US
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Telephone | 609-743-1912
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Fax |
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Provider Business Mailing Address
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Address Line | 3 CLERMONT AVE
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City | EWING
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State | NJ
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Zip | 08618-2615
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Country | US
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Telephone | 609-743-1912
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State |
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