Active NPI
Charles P Waitz, PHD
- Clinical Psychologist
- Medford, NJ
National Provider Identifier
1164514923
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 35SI00109300
- Practice address
- 639 Stokes Rd
Suite 203
Medford, NJ 08055-3003 - Phone
- (609) 953-1222
- Fax
- (609) 714-0095
- NPI assigned
- Sep 29, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 35SI00109300 | NJ | Primary |
| Clinical Psychologist | 103TC0700X | PS002060L | PA |
Addresses
Primary practice location
639 Stokes Rd
Suite 203
Medford, NJ 08055-3003
Mailing address
639 Stokes Rd
Suite 203
Medford, NJ 08055-3003
Phone (609) 953-1222
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS002060L | PA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1164514923",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "639 STOKES RD",
"address_2": "SUITE 203",
"city": "MEDFORD",
"state": "NJ",
"postal_code": "080553003",
"telephone_number": "609-953-1222",
"fax_number": "609-714-0095"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "639 STOKES RD",
"address_2": "SUITE 203",
"city": "MEDFORD",
"state": "NJ",
"postal_code": "080553003",
"telephone_number": "609-953-1222",
"fax_number": "609-714-0095"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAITZ",
"first_name": "CHARLES",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NJ",
"license": "35SI00109300",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PA",
"license": "PS002060L",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.