Individual
CHARLES P FERNICOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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
25MA04460500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3131602
—
NJ
Enumeration date
03/27/2006
Last updated
03/14/2014
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