Healthcare Provider Details

I. General information

NPI: 1225205669
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: 05/14/2008
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 KING OF PRUSSIA RD 4TH FLOOR
RADNOR PA
19087-5220
US

IV. Provider business mailing address

250 KING OF PRUSSIA RD 4TH FLOOR
RADNOR PA
19087-5220
US

V. Phone/Fax

Practice location:
  • Phone: 610-902-1738
  • Fax:
Mailing address:
  • Phone: 610-902-1738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateNULL

VIII. Authorized Official

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