Provider Demographics
NPI:1346207479
Name:CHILTON EMERGENCY PHYSICIANS LLC
Entity Type:Organization
Organization Name:CHILTON EMERGENCY PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GENNARO
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:SR
Authorized Official - Credentials:DO
Authorized Official - Phone:973-831-5000
Mailing Address - Street 1:PO BOX 8500-2721
Mailing Address - Street 2:CHILTON EMERGENCY PHYSICIANS LLC
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-2721
Mailing Address - Country:US
Mailing Address - Phone:800-777-2455
Mailing Address - Fax:610-617-6280
Practice Address - Street 1:97 WEST PARKWAY
Practice Address - Street 2:CHILTON MEMORIAL HOSPITAL
Practice Address - City:POMPTON PLAINE
Practice Address - State:NJ
Practice Address - Zip Code:07444
Practice Address - Country:US
Practice Address - Phone:973-831-5000
Practice Address - Fax:201-444-3604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0052388Medicaid
NJ086966Medicare ID - Type Unspecified