Provider Demographics
NPI:1699860932
Name:TSAKRIOS, CHARLES JR (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:TSAKRIOS
Suffix:JR
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 1:89 N MAPLE AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3235
Mailing Address - Country:US
Mailing Address - Phone:201-445-1991
Mailing Address - Fax:201-445-4827
Practice Address - Street 1:89 N MAPLE AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3235
Practice Address - Country:US
Practice Address - Phone:201-445-1991
Practice Address - Fax:201-445-4827
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA41737207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3295206Medicaid
NJ469537XQ8OtherMEDICARE RENDERING PIN
NJDO6723Medicare UPIN
NJ0338130001Medicare NSC
NJ120640Medicare PIN