Provider Demographics
NPI:1225286297
Name:SCIELZO, CHARLES MILNE (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:MILNE
Last Name:SCIELZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 GRANDVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-4916
Mailing Address - Country:US
Mailing Address - Phone:201-447-5723
Mailing Address - Fax:201-447-3969
Practice Address - Street 1:354 GRANDVIEW CIR
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-4916
Practice Address - Country:US
Practice Address - Phone:201-447-5723
Practice Address - Fax:201-447-3969
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02703100207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJSC35087OtherSTATE MEDICARE NUMBER
NJC52692Medicare UPIN