Provider Demographics
NPI:1417042433
Name:CHILDREN'S HEALTH CARE ASSOCIATES OF NEW JERSEY PC
Entity Type:Organization
Organization Name:CHILDREN'S HEALTH CARE ASSOCIATES OF NEW JERSEY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-567-2422
Mailing Address - Street 1:100 N 20TH ST STE 301
Mailing Address - Street 2:CHCA
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1454
Mailing Address - Country:US
Mailing Address - Phone:215-567-2422
Mailing Address - Fax:215-977-8864
Practice Address - Street 1:1012 LAUREL OAK RD
Practice Address - Street 2:SPECIALTY CENTER AT VOORHEES - CHOP
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:215-977-8864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001025402Medicaid
PA0006558520006Medicaid
NY02278884Medicaid
NJ8241601Medicaid
DE0001025402Medicaid