Provider Demographics
NPI:1598976417
Name:CHILD NEUROLOGY SERVICES OF SOUTHERN NEW JERSEY, P.A.
Entity Type:Organization
Organization Name:CHILD NEUROLOGY SERVICES OF SOUTHERN NEW JERSEY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MINARCIK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:856-722-0100
Mailing Address - Street 1:110 MARTER AVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3124
Mailing Address - Country:US
Mailing Address - Phone:856-722-0100
Mailing Address - Fax:856-722-1107
Practice Address - Street 1:110 MARTER AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3124
Practice Address - Country:US
Practice Address - Phone:856-722-0100
Practice Address - Fax:856-722-1107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0436822084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty