Provider Demographics
NPI:1932657145
Name:CHERRY HILL ASC LLC
Entity Type:Organization
Organization Name:CHERRY HILL ASC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:PONNAPPAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-601-4923
Mailing Address - Street 1:750 ROUTE 73 S
Mailing Address - Street 2:SUITE 303
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4141
Mailing Address - Country:US
Mailing Address - Phone:609-601-4923
Mailing Address - Fax:609-601-4923
Practice Address - Street 1:180 ROUTE 70
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-8703
Practice Address - Country:US
Practice Address - Phone:609-601-4923
Practice Address - Fax:609-601-4923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-16
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJR24566261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical