Provider Demographics
NPI:1043470586
Name:CLINICAL HEALTH CARE ASSOCIATES OF NEW JERSEY, PC
Entity Type:Organization
Organization Name:CLINICAL HEALTH CARE ASSOCIATES OF NEW JERSEY, PC
Other - Org Name:PA ORTHOPEDIC FOOT AND ANKLE SURGEONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ENROLLMENT LEAD
Authorized Official - Prefix:
Authorized Official - First Name:CHANTE
Authorized Official - Middle Name:L
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-662-6187
Mailing Address - Street 1:230 W WASHINGTON SQ
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3500
Mailing Address - Country:US
Mailing Address - Phone:215-829-3668
Mailing Address - Fax:
Practice Address - Street 1:230 W WASHINGTON SQ
Practice Address - Street 2:5TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3500
Practice Address - Country:US
Practice Address - Phone:215-829-3668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Multi-Specialty