Individual
CHARLES ELMENDORF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1825 NJ-35, WALL, NJ 07719
(732) 832-7527
Mailing address
65 MULBERRY ST, MEDFORD, NJ 08055-2618
(609) 410-1842
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
46TR00851900
NJ
Other
Enumeration date
02/05/2020
Last updated
02/05/2020
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