Provider Demographics
NPI:1619062635
Name:CHILDREN'S HEALTH CARE ASSOCIATES OF NEW JERSEY PC
Entity Type:Organization
Organization Name:CHILDREN'S HEALTH CARE ASSOCIATES OF NEW JERSEY PC
Other - Org Name:CHCA NJ NURSE PRACTITIONERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ENROLLMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MIXZA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-425-9233
Mailing Address - Street 1:100 PENN SQUARE EAST, 9TH FL NORTH TOWER
Mailing Address - Street 2:CHCA NJ NURSE PRACTITIONERS
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107
Mailing Address - Country:US
Mailing Address - Phone:267-425-9200
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:1012 LAUREL OAK RD
Practice Address - Street 2:CHCA NJ NURSE PRACTITIONERS
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-3505
Practice Address - Country:US
Practice Address - Phone:856-435-1300
Practice Address - Fax:215-977-8864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0200XNursing Service ProvidersRegistered NursePediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006558520006Medicaid
DE0001025402Medicaid
NY02278884Medicaid
NJ038257N44Medicare ID - Type UnspecifiedCHCA NJ MEDICARE NJ TIN
NJ8241601Medicaid