Healthcare Provider Details

I. General information

NPI: 1932657145
Provider Name (Legal Business Name): CHERRY HILL ASC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2016
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 ROUTE 70
MEDFORD NJ
08055-8703
US

IV. Provider business mailing address

750 ROUTE 73 S STE 303
MARLTON NJ
08053-4191
US

V. Phone/Fax

Practice location:
  • Phone: 609-601-4923
  • Fax: 609-601-4923
Mailing address:
  • Phone: 609-601-4923
  • Fax: 609-601-4923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberR24566
License Number StateNJ

VIII. Authorized Official

Name: RAVI KUMAR PONNAPPAN
Title or Position: PRINICIPAL
Credential: MD
Phone: 609-601-4923