Active NPI
Charlene Olivia Justin, PA-C
- Medical Physician Assistant
- New Haven, CT
National Provider Identifier
1578759536
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 3263
- Practice address
- 800 Howard Ave FL 1
New Haven, CT 06519-1369 - Phone
- (203) 785-7411
- Fax
- (203) 785-4194
- NPI assigned
- Sep 23, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 51298 | CA | |
| Physician Assistant | 363A00000X | 0010-06058 | NC | |
| Medical Physician Assistant | 363AM0700X | 3263 | CT | Primary |
Addresses
Primary practice location
800 Howard Ave FL 1
New Haven, CT 06519-1369
Mailing address
800 Howard Ave
New Haven, CT 06519-1369
Phone (650) 759-1426
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ENROLLED | Medicaid | MN |
Other names 1
- Ms. Charlene Olivia Justin
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3263 | CT | MD | Professional Counselor |
| 0010-06058 | NC | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190505600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1564876800000",
"number": "1578759536",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 HOWARD AVE",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "065191369",
"telephone_number": "650-759-1426"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 HOWARD AVE FL 1",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "065191369",
"telephone_number": "203-785-7411",
"fax_number": "203-785-4194"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JUSTIN",
"first_name": "CHARLENE",
"middle_name": "OLIVIA",
"name_prefix": "Ms.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-09-23",
"last_updated": "2019-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "51298",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "0010-06058",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "CT",
"license": "3263",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "ENROLLED",
"state": "MN"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "CHARLENE",
"last_name": "JUSTIN",
"middle_name": "OLIVIA",
"prefix": "MS.",
"code": "5",
"type": "Other Name"
}
]
}Other providers in New Haven, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.