Provider Demographics
NPI:1023047180
Name:RANCOCAS OBSTETRICS AND GYNECOLOGY ASSOCIATES, LLC
Entity type:Organization
Organization Name:RANCOCAS OBSTETRICS AND GYNECOLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-877-8777
Mailing Address - Street 1:220 SUNSET RD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-1126
Mailing Address - Country:US
Mailing Address - Phone:609-877-8777
Mailing Address - Fax:609-877-2497
Practice Address - Street 1:220 SUNSET RD
Practice Address - Street 2:SUITE 1B
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-1126
Practice Address - Country:US
Practice Address - Phone:609-877-8777
Practice Address - Fax:609-877-2497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1K7588OtherHEALTHNET PROVIDER ID
NJP2039932OtherOXFORD PROVIDER ID
NJ0060481000OtherAMERIHEALTH PROVIDER ID
NJ0877648000OtherKEYSTONE PROVIDER ID
NJ7903600Medicaid
NJ2456024OtherAETNA PROVIDER ID
NJ0060481000OtherAMERIHEALTH PROVIDER ID
NJ7903600Medicaid