=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023047180
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RANCOCAS OBSTETRICS AND GYNECOLOGY ASSOCIATES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 220 SUNSET RD SUITE 1B
-----------------------------------------------------
City | WILLINGBORO
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08046-1126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-877-8777
-----------------------------------------------------
Fax | 609-877-2497
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 220 SUNSET RD SUITE 1B
-----------------------------------------------------
City | WILLINGBORO
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08046-1126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-877-8777
-----------------------------------------------------
Fax | 609-877-2497
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. KENNETH H CHEN
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 609-877-8777
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------