Provider Demographics
NPI:1356566996
Name:CHAOUCH, ADEL B SR
Entity type:Individual
Prefix:MR
First Name:ADEL
Middle Name:B
Last Name:CHAOUCH
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 HADDON AVE
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-3121
Mailing Address - Country:US
Mailing Address - Phone:856-966-9500
Mailing Address - Fax:856-966-9800
Practice Address - Street 1:1450 HADDON AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-3121
Practice Address - Country:US
Practice Address - Phone:856-966-9500
Practice Address - Fax:856-966-9800
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJVIPT00617343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1140891OtherHORIZON NJ HEALTH
NJ89926OtherAMERIGROUP
NJ2K0677OtherHEALTH NET
NJ7277504Medicaid
NJ01000275100OtherAMERICHOICE OF NEW JERSEY