Provider Demographics
NPI:1891870432
Name:CHOP CLINICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:CHOP CLINICAL ASSOCIATES, INC
Other - Org Name:CHOP PRIMARY CARE MOORESTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TODOROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-426-6940
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 1:200 MARTER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3114
Practice Address - Country:US
Practice Address - Phone:856-235-2147
Practice Address - Fax:856-235-6905
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHOP CLINICAL ASSOCIATES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-25
Last Update Date:2023-02-04
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
NJ2591502Medicaid