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NPI Code Detail

MEDICARE: CHARLES E. GRANATIR, M.D.

MEDICARE: CHARLES E. GRANATIR, M.D.
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
1174400000XSpecialistMA047062NJ

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1518001OTHERNJMEDICARE PROVIDER

General Provider Information

NPI Number : 1508019829
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHARLES E. GRANATIR, M.D.
Provider Business Mailing Address
First Line : 586 KEARNY AVE
Second Line :
City : KEARNY
State : NJ
Zip : 07032-2806
Country : US
Telephone Number : 201-997-7667
Fax Number : 201-997-3324
Provider Business Practice Location Address
First Line : 586 KEARNY AVE
Second Line :
City : KEARNY
State : NJ
Zip : 07032-2806
Country : US
Telephone Number : 201-997-7667
Fax Number : 201-997-3324
Authorized Official
Title or Position : PHYSICIAN
Name : CHARLES E GRANATIR
Credential : MD
Telephone Number : 201-997-7667
Provider Enumeration Date : 10/30/2008
Last Update Date : 07/20/2015

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Directions to “CHARLES E. GRANATIR, M.D. ” Practice Location

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