Healthcare Provider Details

I. General information

NPI: 1043470586
Provider Name (Legal Business Name): CLINICAL HEALTH CARE ASSOCIATES OF NEW JERSEY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 W WASHINGTON SQ 5TH FLOOR
PHILADELPHIA PA
19106-3500
US

IV. Provider business mailing address

230 W WASHINGTON SQ 5TH FLOOR
PHILADELPHIA PA
19106-3500
US

V. Phone/Fax

Practice location:
  • Phone: 215-829-3668
  • Fax:
Mailing address:
  • Phone: 215-829-3668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: STACY GRECO
Title or Position: SR. ENROLLMENT MANAGER
Credential:
Phone: 223-341-8516