Basic Information
Provider Information
NPI: 1457304685
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHARTOFF
FirstName: AMY
MiddleName: J
NamePrefix: MRS.
NameSuffix:  
Credential: RN, APN,C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 592 HILLSIDE ST
Address2:  
City: RIDGEFIELD
State: NJ
PostalCode: 076572430
CountryCode: US
TelephoneNumber: 2019433211
FaxNumber:  
Practice Location
Address1: 30 PROSPECT AVE
Address2: PC 251
City: HACKENSACK
State: NJ
PostalCode: 076011915
CountryCode: US
TelephoneNumber: 5519965329
FaxNumber: 5519960115
Other Information
ProviderEnumerationDate: 05/18/2006
LastUpdateDate: 05/04/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0200X26NN04959200NJY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics

No ID Information.


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