Active NPI
Charles Elmendorf
- Occupational Therapist
- Wall, NJ
National Provider Identifier
1881226181
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 46TR00851900
- Practice address
- 1825 NJ-35
Wall, NJ 07719 - Phone
- (732) 832-7527
- NPI assigned
- Feb 5, 2020
- Last updated
- Feb 5, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 46TR00851900 | NJ | Primary |
Addresses
Primary practice location
1825 NJ-35
Wall, NJ 07719
Mailing address
65 Mulberry St
Medford, NJ 08055-2618
Phone (609) 410-1842
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1580860800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580860800000",
"number": "1881226181",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "65 MULBERRY ST",
"city": "MEDFORD",
"state": "NJ",
"postal_code": "080552618",
"telephone_number": "609-410-1842"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1825 NJ-35",
"city": "WALL",
"state": "NJ",
"postal_code": "07719",
"telephone_number": "732-832-7527"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELMENDORF",
"first_name": "CHARLES",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-02-05",
"last_updated": "2020-02-05",
"certification_date": "2020-02-05",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NJ",
"license": "46TR00851900",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wall, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.