Provider Demographics
NPI:1437606100
Name:CHRISTIAN MEDICAL CENTRE, PC
Entity Type:Organization
Organization Name:CHRISTIAN MEDICAL CENTRE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-469-4673
Mailing Address - Street 1:897 PARKWAY AVE
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-2305
Mailing Address - Country:US
Mailing Address - Phone:856-344-9009
Mailing Address - Fax:856-997-9262
Practice Address - Street 1:897 PARKWAY AVE
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08618-2305
Practice Address - Country:US
Practice Address - Phone:856-344-9009
Practice Address - Fax:856-997-9262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA091266300261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0302457Medicaid