Provider Demographics
NPI:1831303320
Name:CLINICAL HEALTH CARE ASSOCIATES OF NEW JERSEY, PC
Entity type:Organization
Organization Name:CLINICAL HEALTH CARE ASSOCIATES OF NEW JERSEY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENROLLMENT LEAD
Authorized Official - Prefix:
Authorized Official - First Name:CHANTE
Authorized Official - Middle Name:L
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-662-6187
Mailing Address - Street 1:2301 E EVESHAM RD
Mailing Address - Street 2:BLDG 800, STE 221
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4501
Mailing Address - Country:US
Mailing Address - Phone:856-772-1225
Mailing Address - Fax:856-772-6336
Practice Address - Street 1:2301 E EVESHAM RD
Practice Address - Street 2:BLDG 800, STE 221
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4501
Practice Address - Country:US
Practice Address - Phone:856-772-1225
Practice Address - Fax:856-772-6336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2331798OtherAETNA
NJ0898192000OtherNJ AMERIHEALTH
NJ7154208Medicaid
NJ999251OtherNJ BLUE SHIELD
NJ0898192000OtherNJ AMERIHEALTH