Healthcare Provider Details

I. General information

NPI: 1881789808
Provider Name (Legal Business Name): CHILDREN'S HEALTHCARE ASSOCIATES OF NEW JERSEY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 LAUREL OAK RD CHOP CARE NETWORK AT VOORHEES SCC
VOORHEES NJ
08043-3505
US

IV. Provider business mailing address

100 E PENN SQ FL 9 CHILDREN'S HEALTHCARE ASSOCIATES OF NEW JERSEY PC
PHILADELPHIA PA
19107-3323
US

V. Phone/Fax

Practice location:
  • Phone: 856-435-1300
  • Fax: 267-425-9299
Mailing address:
  • Phone: 267-425-9233
  • Fax: 267-425-9299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number
License Number State

VIII. Authorized Official

Name: MIXZA SANTA
Title or Position: ENROLLMENT MANAGER
Credential:
Phone: 267-425-9233