Provider Demographics
NPI:1215022231
Name:CHILDREN'S HEALTHCARE ASSOCIATES OF NEW JERSEY PC
Entity Type:Organization
Organization Name:CHILDREN'S HEALTHCARE ASSOCIATES OF NEW JERSEY PC
Other - Org Name:CHCA NJ NEPHROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ENROLLMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MIXZA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-425-9233
Mailing Address - Street 1:100 E PENN SQ FL 9
Mailing Address - Street 2:CHILDREN'S HEALTHCARE ASSOCIATES OF NEW JERSEY PC
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3323
Mailing Address - Country:US
Mailing Address - Phone:267-425-9233
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:1012 LAUREL OAK RD
Practice Address - Street 2:CHOP CARE NETWORK AT VOORHEES SCC
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-3505
Practice Address - Country:US
Practice Address - Phone:856-435-1300
Practice Address - Fax:267-425-9299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric NephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02278884Medicaid
DE0001025402Medicaid
PA0006558520006Medicaid
NJ8241601Medicaid
PAPENDINGMedicare PIN