Provider Demographics
NPI:1558394718
Name:CAPE PEDIATRIC ASSOCIATES PA
Entity Type:Organization
Organization Name:CAPE PEDIATRIC ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHALERM
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNHACHAWEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-465-7831
Mailing Address - Street 1:301 COURT HOUSE S DENNIS RD
Mailing Address - Street 2:CAPE PEDIATRIC ASSOCIATES PA
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-1996
Mailing Address - Country:US
Mailing Address - Phone:609-465-7831
Mailing Address - Fax:609-463-0273
Practice Address - Street 1:301 COURT HOUSE S DENNIS RD
Practice Address - Street 2:CAPE PEDIATRIC ASSOCIATES PA
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-1996
Practice Address - Country:US
Practice Address - Phone:609-465-7831
Practice Address - Fax:609-463-0273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02796000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0732508Medicaid