Provider Demographics
NPI:1518974252
Name:CHILD HEALTH ASSOCIATES PA
Entity Type:Organization
Organization Name:CHILD HEALTH ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ESME
Authorized Official - Middle Name:
Authorized Official - Last Name:DAYARATNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-750-1521
Mailing Address - Street 1:666 PLAINSBORO RD
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-3030
Mailing Address - Country:US
Mailing Address - Phone:609-750-1521
Mailing Address - Fax:609-750-1523
Practice Address - Street 1:666 PLAINSBORO RD
Practice Address - Street 2:SUITE 1300
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536-3030
Practice Address - Country:US
Practice Address - Phone:609-750-1521
Practice Address - Fax:609-750-1523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA065150174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8283605Medicaid
NJ067730Medicare ID - Type Unspecified
NJG90956Medicare UPIN