Provider Demographics
NPI:1790869287
Name:CHILDREN'S SURGICAL ASSOCIATES OF NEW JERSEY INC
Entity Type:Organization
Organization Name:CHILDREN'S SURGICAL ASSOCIATES OF NEW JERSEY INC
Other - Org Name:CHILDREN'S SURGICAL ASSOC., OF NJ INC. PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:FLOCCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-977-9507
Mailing Address - Street 1:1601 WALNUT ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-2944
Mailing Address - Country:US
Mailing Address - Phone:215-977-9507
Mailing Address - Fax:215-977-8794
Practice Address - Street 1:1012 LAUREL OAK RD
Practice Address - Street 2:SUITE 1
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:856-435-0091
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S SURGICAL ASSOC., OF NEW JERSEY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-24
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty