Charles S Corallo, D.C.
Individual provider Active NPI Chiropractor · Oakland, NJ
NPI 1689699753 · NPPES record last updated Nov 7, 2018
Key facts
- NPI
- 1689699753
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- MC001845 (NJ)
- Practice address
- 191 Ramapo Valley Rd
Oakland, NJ 07436-2509 - Phone
- (201) 651-0051
- Fax
- (201) 651-0064
- NPI assigned
- Jul 12, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MC001845 | NJ | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | MC001845 | NJ | Yes |
Addresses
Primary practice location
191 Ramapo Valley Rd
Oakland, NJ 07436-2509
Mailing address
191 Ramapo Valley Rd
Oakland, NJ 07436-2509
Phone (201) 651-0051
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6428509 | Medicaid | NJ |
Other providers in Oakland, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 7, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.