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General NPI Number Information
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NPI Number | 1417282922
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Entity Type | Organization
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Legal Business Name | J CALVIN CHATLOS MD LLC
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Dates
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Enumeration Date | 10/16/2009
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Last Update Date | 10/16/2009
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Provider Practice Location Address
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Address Line | 400 W MAIN ST
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City | FREEHOLD
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State | NJ
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Zip | 07728-2529
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Country | US
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Telephone | 732-414-6001
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Fax | 732-677-3149
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Provider Business Mailing Address
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Address Line | 400 W MAIN ST
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City | FREEHOLD
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State | NJ
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Zip | 07728-2529
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Country | US
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Telephone | 732-414-6001
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Fax | 732-677-3149
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. JOHN CALVIN CHATLOS JR.
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Credential | MD
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Telephone | 732-414-6001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number | MA 46262
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MA 46262
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number | MA 46262
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | MA 46262
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License Number State | NJ
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