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NPI Code Detail

MEDICARE: CHARLES CHRISTOPHER CONNELLY

MEDICARE: CHARLES CHRISTOPHER CONNELLY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor

General Provider Information

NPI Number : 1285728436
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES CHRISTOPHER CONNELLY
Provider Business Mailing Address
First Line : 316 N SCOTT AVE
Second Line :
City : GLENOLDEN
State : PA
Zip : 19036-1341
Country : US
Telephone Number : 610-532-3034
Fax Number :
Provider Business Practice Location Address
First Line : 55 N CLINTON AVE
Second Line :
City : TRENTON
State : NJ
Zip : 08609-1011
Country : US
Telephone Number : 609-278-1213
Fax Number : 609-278-0606
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2006
Last Update Date : 07/08/2007

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Directions to “ CHARLES CHRISTOPHER CONNELLY ” Practice Location

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