Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 25MB04030300 | NJ |
Y | 207QA0505X | Family Doctor - Adult Medicine | 25MB04030300 | NJ |
NPI | 1194816207 |
---|---|
Provider Name | Dr. Charles Weston Hayne |
First Address | Holmdel, NJ 07733-2115 |
Second Address | Freehold, NJ 07728-2964 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 03/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C53861 | (02) | NJ |