Provider Demographics
NPI:1194816207
Name:HAYNE, CHARLES WESTON (DO)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WESTON
Last Name:HAYNE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:27 WILDHEDGE LN
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-2115
Mailing Address - Country:US
Mailing Address - Phone:732-946-7249
Mailing Address - Fax:
Practice Address - Street 1:77 SCHANCK RD # 55
Practice Address - Street 2:B-17
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2964
Practice Address - Country:US
Practice Address - Phone:732-462-1036
Practice Address - Fax:732-462-6882
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB04030300207Q00000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC53861Medicare UPIN
NJ457084QXBMedicare ID - Type Unspecified