Healthcare Provider Details

I. General information

NPI: 1629094156
Provider Name (Legal Business Name): SILVER CKD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 BRACE RD
CHERRY HILL NJ
08034-3524
US

IV. Provider business mailing address

1417 BRACE RD
CHERRY HILL NJ
08034-3524
US

V. Phone/Fax

Practice location:
  • Phone: 856-795-3131
  • Fax: 856-795-7062
Mailing address:
  • Phone: 856-795-3131
  • Fax: 856-795-7062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number22241
License Number StateNJ

VIII. Authorized Official

Name: MARC SILVER
Title or Position: PRESIDENT
Credential:
Phone: 856-795-3131