Provider Demographics
NPI:1336275585
Name:DIAMENT, CHARLES (PHD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:DIAMENT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CRAWFORD CORNER ROAD
Mailing Address - Street 2:POB 634
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733
Mailing Address - Country:US
Mailing Address - Phone:732-530-9330
Mailing Address - Fax:
Practice Address - Street 1:10 CRAWFORDS CORNER RD
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1975
Practice Address - Country:US
Practice Address - Phone:732-530-9330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1345103T00000X
NJSI 01345103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ604500Medicare ID - Type Unspecified
NJR32526Medicare UPIN