1194964593 NPI number — CHILDREN'S HEALTHCARE ASSOCIATES OF NEW JERSEY, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194964593 NPI number — CHILDREN'S HEALTHCARE ASSOCIATES OF NEW JERSEY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN'S HEALTHCARE ASSOCIATES OF NEW JERSEY, PC
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:
1194964593
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 E PENN SQ FL 9
Provider Second Line Business Mailing Address:
CHILDREN'S HEALTHCARE ASSOCIATES OF NEW JERSEY PC
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19107-3323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-425-9233
Provider Business Mailing Address Fax Number:
267-425-9299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 PLAINSBORO RD
Provider Second Line Business Practice Location Address:
CHOP CARE NETWORK AT PRINCETON MEDICAL CENTER
Provider Business Practice Location Address City Name:
PLAINSBORO
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08536-1913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-497-4431
Provider Business Practice Location Address Fax Number:
267-425-9299
Provider Enumeration Date:
02/10/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SANTA
Authorized Official First Name:
MIXZA
Authorized Official Middle Name:
Authorized Official Title or Position:
ENROLLMENT MANAGER
Authorized Official Telephone Number:
267-425-9233

Provider Taxonomy Codes

  • Taxonomy code: 2080N0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02278884 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8241601 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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