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NPI Code Detail

MEDICARE: DR. CHARLENE HARGROVE BURN MD

MEDICARE: DR. CHARLENE HARGROVE BURN MD
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
12084P0800XPsychiatry Physician25MA02337000NJ
22084P0800XPsychiatry Physician044996CT
32084P0800XPsychiatry Physician23370NY

General Provider Information

NPI Number : 1568678555
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLENE HARGROVE BURN MD
Provider Business Mailing Address
First Line : 49 RIVERVIEW TERRACE
Second Line :
City : UPPER SADDLE RIVER
State : NJ
Zip : 07458-2006
Country : US
Telephone Number : 201-760-9709
Fax Number : 201-760-9402
Provider Business Practice Location Address
First Line : 49 RIVERVIEW TERRACE
Second Line :
City : UPPER SADDLE RIVER
State : NJ
Zip : 07458-2006
Country : US
Telephone Number : 201-760-9709
Fax Number : 201-760-9402
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2007
Last Update Date : 07/08/2007

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