Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 38MC00758100 | NJ |
NPI | 1992278881 |
---|---|
Provider Name | Dr. Charles Anthony Marotta |
First Address | Forked River, NJ 08731-4654 |
Second Address | Forked River, NJ 08731-4654 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2019 |
Last Update Date | 03/01/2019 |