Provider Demographics
NPI:1174983498
Name:CHILDRENS RADIOLOGY ASSOCIATES OF NEW JERSEY PC
Entity type:Organization
Organization Name:CHILDRENS RADIOLOGY ASSOCIATES OF NEW JERSEY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENROLLMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERISH
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-425-9408
Mailing Address - Street 1:100 E PENN SQ FL 9
Mailing Address - Street 2:RACH NJ
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3377
Mailing Address - Country:US
Mailing Address - Phone:267-425-9408
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:1012 LAUREL OAK RD
Practice Address - Street 2:RACH NJ @VOORHEES SCC
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-3505
Practice Address - Country:US
Practice Address - Phone:267-425-9233
Practice Address - Fax:267-425-9625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-29
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric RadiologyGroup - Multi-Specialty