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General NPI Number Information
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NPI Number | 1790891802
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Entity Type | Individual
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Provider Name | CHARLES W FARRELL M.D
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Gender | Male
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 409 MAIN ST FL 2
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City | TOMS RIVER
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State | NJ
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Zip | 08753-7441
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Country | US
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Telephone | 732-818-7575
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Fax |
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Provider Business Mailing Address
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Address Line | 331 NEWMAN SPRINGS RD STE 220
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City | RED BANK
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State | NJ
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Zip | 07701-5792
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Country | US
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Telephone | 732-807-0877
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 25MA06350900
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License Number State | NJ
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