Provider Demographics
NPI:1548358641
Name:CHERRY HILL FAMILY PRACTICE, P.A.
Entity type:Organization
Organization Name:CHERRY HILL FAMILY PRACTICE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SIRKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-779-7779
Mailing Address - Street 1:401 COOPER LANDING RD
Mailing Address - Street 2:SUITE C-22
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-2517
Mailing Address - Country:US
Mailing Address - Phone:856-779-7779
Mailing Address - Fax:856-779-7790
Practice Address - Street 1:401 COOPER LANDING RD
Practice Address - Street 2:SUITE C-22
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2517
Practice Address - Country:US
Practice Address - Phone:856-779-7779
Practice Address - Fax:856-779-7790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05550800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5226201Medicaid
NJ5226201Medicaid