Healthcare Provider Details

I. General information

NPI: 1063858124
Provider Name (Legal Business Name): CHOP CLINICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 07/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4009 BLACK HORSE PIKE
MAYS LANDING NJ
08330
US

IV. Provider business mailing address

301 LINDENWOOD DRIVE SUITE 350
MALVERN PA
19355
US

V. Phone/Fax

Practice location:
  • Phone: 609-677-7895
  • Fax: 609-677-7835
Mailing address:
  • Phone: 215-590-2897
  • Fax: 215-590-0325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LANCE CASTLE
Title or Position: BILLING DIRECTOR
Credential:
Phone: 215-590-5317