Healthcare Provider Details

I. General information

NPI: 1750476776
Provider Name (Legal Business Name): CHILDREN'S HEALTH CARE ASSOCIATES OF NEW JERSEY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 LAUREL OAK RD SPECIALTY CENTER AT VOORHEES - CHOP
VOORHEES NJ
08043-3505
US

IV. Provider business mailing address

100 N 20TH ST STE 301 CHCA
PHILADELPHIA PA
19103-1454
US

V. Phone/Fax

Practice location:
  • Phone: 856-435-1300
  • Fax: 215-977-8864
Mailing address:
  • Phone: 215-567-2422
  • Fax: 215-561-0959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL CORBO
Title or Position: FINANCE OFFICER
Credential:
Phone: 215-567-2422