Basic Information
| Provider Information | |||||||||
| NPI: | 1346207479 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHILTON EMERGENCY PHYSICIANS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8500-2721 | ||||||||
| Address2: | CHILTON EMERGENCY PHYSICIANS LLC | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191782721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007772455 | ||||||||
| FaxNumber: | 6106176280 | ||||||||
| Practice Location | |||||||||
| Address1: | 97 WEST PARKWAY | ||||||||
| Address2: | CHILTON MEMORIAL HOSPITAL | ||||||||
| City: | POMPTON PLAINE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738315000 | ||||||||
| FaxNumber: | 2014443604 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MARINO | ||||||||
| AuthorizedOfficialFirstName: | GENNARO | ||||||||
| AuthorizedOfficialMiddleName: | JOSEPH | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9738315000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | SR. | ||||||||
| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0052388 | 05 | NJ | MEDICAID |