Provider Demographics
NPI:1487607701
Name:CHERRY HILL HEALTH CARE ASSOCIATES PA
Entity type:Organization
Organization Name:CHERRY HILL HEALTH CARE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:YAROSLAW
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOLYBABIUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-488-3505
Mailing Address - Street 1:701 BORTON LANDING RD
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3925
Mailing Address - Country:US
Mailing Address - Phone:856-866-2651
Mailing Address - Fax:856-273-7642
Practice Address - Street 1:701 BORTON LANDING RD
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3925
Practice Address - Country:US
Practice Address - Phone:856-866-2651
Practice Address - Fax:856-273-7642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ158158Medicare ID - Type UnspecifiedPROVIDER NUMBER