1215022256 NPI number — CHILDREN'S HEALTH CARE ASSOCIATES OF NEW JERSEY PC

Table of content: (NPI 1215022256)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215022256 NPI number — CHILDREN'S HEALTH CARE ASSOCIATES OF NEW JERSEY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN'S HEALTH CARE ASSOCIATES OF NEW JERSEY PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215022256
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 N 20TH ST STE 301
Provider Second Line Business Mailing Address:
CHCA
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-567-2422
Provider Business Mailing Address Fax Number:
215-977-8864

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1012 LAUREL OAK ROAD
Provider Second Line Business Practice Location Address:
SPECIALTY CENTER AT VOORHEES - CHOP
Provider Business Practice Location Address City Name:
VOORHEES
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-435-1300
Provider Business Practice Location Address Fax Number:
215-977-8864
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CREDENTIALING COORDINATOR
Authorized Official Telephone Number:
215-567-2422

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02278884 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0001025402 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0006558520006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8241601 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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