Individual
MR. CHARLES SIDWA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1322 ROUTE 72 W, SUITE 201, MANAHAWKIN, NJ 08050
(800) 337-6663
Mailing address
1580 LAKEWOOD RD STE 16, TOMS RIVER, NJ 08755-3287
(732) 456-7777
(848) 251-2189
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
25MP00052400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
320562
AMERICAID/AMERIGROUP
NJ
01
—
3K3524
HEALTHNET
NJ
Enumeration date
05/10/2006
Last updated
08/04/2021
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