Provider Demographics
NPI:1104250117
Name:CELESTINE, CHARLSIE KHALISHA (MD)
Entity type:Individual
Prefix:
First Name:CHARLSIE
Middle Name:KHALISHA
Last Name:CELESTINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 US HIGHWAY 130 STE 29D
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-2735
Mailing Address - Country:US
Mailing Address - Phone:609-607-6600
Mailing Address - Fax:609-371-0346
Practice Address - Street 1:319 US HIGHWAY 130 STE 29D
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-2735
Practice Address - Country:US
Practice Address - Phone:609-607-6600
Practice Address - Fax:609-371-0346
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV27031207V00000X
NJ25MA09840000207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1104250117Medicaid