Provider Demographics
NPI:1619057437
Name:CHOP CLINICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:CHOP CLINICAL ASSOCIATES, INC
Other - Org Name:CARE NETWORK SOMERS POINT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-590-5317
Mailing Address - Street 1:3401 CIVIC CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4319
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:505 BAY AVE. BAYSIDE COMMONS. SUITE 101
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2563
Practice Address - Country:US
Practice Address - Phone:609-927-4235
Practice Address - Fax:609-927-5590
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHOP CLINICAL ASSOCIATES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-16
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3398901Medicaid