Organization
CLC MEDICAL SERVICES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES CHANDLER (PHYSICIAN ASSISTANT)
(973) 986-4013
Entity
Organization
Contact information
Practice address
150 BAY ST, SUITE 915, JERSEY CITY, NJ 07302-2900
(973) 986-4013
Mailing address
150 BAY ST, SUITE 915, JERSEY CITY, NJ 07302-2900
(973) 986-4013
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MP00056300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1417996
NATIONAL PROVIDER INDIVUA
NJ
Enumeration date
06/24/2006
Last updated
08/22/2020
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