=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932657145
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHERRY HILL ASC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2016
-----------------------------------------------------
Last Update Date | 12/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 180 ROUTE 70
-----------------------------------------------------
City | MEDFORD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08055-8703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-601-4923
-----------------------------------------------------
Fax | 609-601-4923
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 750 ROUTE 73 S STE 303
-----------------------------------------------------
City | MARLTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08053-4191
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-601-4923
-----------------------------------------------------
Fax | 609-601-4923
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRINICIPAL
-----------------------------------------------------
Name | RAVI KUMAR PONNAPPAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 609-601-4923
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | R24566
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------