Ellis B Charles, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

25MA05127300 Issued in NJ

Practice address

90 Washington St
East Orange, NJ 07017-1050

Phone

(973) 672-2555

Fax

(973) 672-2529

NPI assigned

Mar 4, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Eoh Acquisition Group, LLC

  • General Acute Care Hospital
  • East Orange, NJ
  • NPI 1013386143
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362441600000",
    "number": "1013046341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 LONGVIEW AVE",
            "city": "RANDOLPH",
            "state": "NJ",
            "postal_code": "078693008",
            "telephone_number": "973-895-5062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 WASHINGTON ST",
            "city": "EAST ORANGE",
            "state": "NJ",
            "postal_code": "070171050",
            "telephone_number": "973-672-2555",
            "fax_number": "973-672-2529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHARLES",
        "first_name": "ELLIS",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-04",
        "last_updated": "2013-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "132910",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NJ",
            "license": "25MA05127300",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "GA",
            "license": "18284",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0866300",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Chahua
• Alexa N Chandler, LCSW
• Sameep Chandrani, DPM
• Kulandaivelu Chandrasekaran, M.D.
• Victor Tsu Shih Chang, MD
• Jumanne Charles
• Uzma Arshad Chatha, M.D.
• Chatman Transit Corp
• Chelsea Hospital Physicians, P.a.
• Lawrence Chen

• All providers in East Orange, NJ
• Psychiatry Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.