Provider Demographics
NPI:1720009830
Name:CHONA SANTOS-MIRANDA M.D.PC
Entity Type:Organization
Organization Name:CHONA SANTOS-MIRANDA M.D.PC
Other - Org Name:EGG HARBOR MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHONA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS-MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-965-5700
Mailing Address - Street 1:630 BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1935
Mailing Address - Country:US
Mailing Address - Phone:609-965-5700
Mailing Address - Fax:609-965-5719
Practice Address - Street 1:217 PHILADELPHIA AVE
Practice Address - Street 2:
Practice Address - City:EGG HARBOR CITY
Practice Address - State:NJ
Practice Address - Zip Code:08215-1330
Practice Address - Country:US
Practice Address - Phone:609-965-5700
Practice Address - Fax:609-965-5719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06592600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG87104Medicare UPIN