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General NPI Number Information
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NPI Number | 1508019829
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Entity Type | Organization
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Legal Business Name | CHARLES E. GRANATIR, M.D.
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Dates
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Enumeration Date | 10/30/2008
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Last Update Date | 07/20/2015
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Provider Practice Location Address
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Address Line | 586 KEARNY AVE
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City | KEARNY
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State | NJ
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Zip | 07032-2806
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Country | US
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Telephone | 201-997-7667
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Fax | 201-997-3324
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Provider Business Mailing Address
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Address Line | 586 KEARNY AVE
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City | KEARNY
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State | NJ
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Zip | 07032-2806
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Country | US
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Telephone | 201-997-7667
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Fax | 201-997-3324
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Authorized Official
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Title or Position | PHYSICIAN
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Name | CHARLES E GRANATIR
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Credential | MD
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Telephone | 201-997-7667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA047062
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License Number State | NJ
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