Provider Demographics
NPI:1639895055
Name:CHRYSALIS HEALTH OF NJ
Entity Type:Organization
Organization Name:CHRYSALIS HEALTH OF NJ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-248-7508
Mailing Address - Street 1:136 E 76TH ST APT 8F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2831
Mailing Address - Country:US
Mailing Address - Phone:434-248-7508
Mailing Address - Fax:213-340-5870
Practice Address - Street 1:386 PARK AVE S FL 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8815
Practice Address - Country:US
Practice Address - Phone:434-248-7508
Practice Address - Fax:213-340-5870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty