1184708679 NPI number — CHILDREN'S SURGICAL ASSOCIATES OF NEW JERSEY INC

Table of content: (NPI 1184708679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184708679 NPI number — CHILDREN'S SURGICAL ASSOCIATES OF NEW JERSEY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN'S SURGICAL ASSOCIATES OF NEW JERSEY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184708679
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3401 CIVIC CENTER BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19104-4319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-425-9507
Provider Business Mailing Address Fax Number:
267-425-9552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1012 LAUREL OAK RD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
VOORHEES
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08043-3505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-435-1300
Provider Business Practice Location Address Fax Number:
856-435-0091
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FLOCCO
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
C
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
215-977-9507

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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