Provider Demographics
NPI:1548575269
Name:KAULESAR, CHANMONIE (ANP-C, GNP-C)
Entity type:Individual
Prefix:DR
First Name:CHANMONIE
Middle Name:
Last Name:KAULESAR
Suffix:
Gender:F
Credentials:ANP-C, GNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 BERGEN STREET
Mailing Address - Street 2:SUITE 3400
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2425
Mailing Address - Country:US
Mailing Address - Phone:973-972-2085
Mailing Address - Fax:973-972-2130
Practice Address - Street 1:90 BERGEN ST
Practice Address - Street 2:SUITE 3400
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2425
Practice Address - Country:US
Practice Address - Phone:973-972-2085
Practice Address - Fax:973-972-2130
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00268300363L00000X, 364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner