Organization
CHARLES P FERNICOLA MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MICHELE M KENNEDY (OFFICE MANAGER)
(609) 597-1991
Entity
Organization
Contact information
Practice address
1145 BEACON AVE, MANAHAWKIN, NJ 08050-2471
(609) 597-1991
(609) 597-8198
Mailing address
1145 BEACON AVE, MANAHAWKIN, NJ 08050-2471
(609) 597-1991
(609) 597-8198
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3131602
—
NJ
Enumeration date
01/08/2007
Last updated
06/05/2009
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