SRC PENDING CONSULT MANAGEMENT (NPI# 1366433534) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366433534 |
| Entity Type | Organization |
| Organization Name | SRC PENDING CONSULT MANAGEMENT |
| Practice Address |
5250 Maryland Ave Fort Dix NJ 08640-5058 |
| Mailing Address |
1312 Paris Ct Lakewood NJ 08701-3724 |
| Practice Telephone | 6095626312 |
| Mailing Telephone | 7322677737 |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MS. CHRISTALA CHERRY (CASE MANAGER) |
| Authorized Official Telephone | 6095626312 |
| Authorized Official Credential | RN, BSN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | 26NR09534400 | NJ | Ambulatory Health Care Facilities |
| Street Address |
5250 MARYLAND AVE |
| City | FORT DIX |
| State | NJ |
| Zip Code | 08640-5058 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255303285 | Persival Faustino Borlongan | Physical Therapist | 5250 Maryland Ave, Src (rear of Walson), Fort Dix, NJ 08640-5058 | 2006-02-03 |
| 1164494357 | Joy A Hoffman | Physical Therapy Assistant | 5250 Maryland Ave, Fort Dix, NJ 08640-5058 | 2006-02-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841428174 | Joseph Nunzio Coyle | Military Health Care Provider | 5651 Texas Ave., Fort Dix, NJ 08640 | 2009-06-25 |
| 1114128832 | Philadelphia Va Medical Center | Clinic/Center | 8th and Alabama St, Building 5437, Fort Dix, NJ 08640 | 2007-05-30 |
| 1467653501 | Scott J Winters | Registered Nurse | United States Army, Walson Army Hospital, Ft Dix, NJ 08640 | 2007-05-29 |
| 1700091147 | Kenneth Harry Schmidt | Pharmacist | 5756 Hartford Road, Fort Dix, NJ 08640 | 2007-05-11 |
| 1669692943 | Robert Antonio Cabanas | Dentist | 5755 Hartford Rd, Fci Fort Dix, Fort Dix, NJ 08640 | 2007-04-27 |
| 1063569556 | Erwin Hillard Goldrich | Dentist | 5660 Doughboy Ave, Fort Dix, NJ 08640 | 2007-01-05 |
| 1407918022 | James Richard Ross | Dentist | 5660 Doughboy Loop, Mills Dental Clinic, Fort Dix, NJ 08640 | 2006-12-14 |
| 1235212358 | John Joseph Sweeney IIi | Internal Medicine | Eighth and Alabama, Outpatient Clinic At Marshall Hall, Fort Stdix, NJ 08640 | 2006-10-23 |
| 1154421196 | Anthony Louis Capone | Social Worker | 8th Streeet Building 5437, Fort Dix, NJ 08640 | 2006-09-22 |
| 1528167970 | Keller Army Community Hospital | Military/U.S. Coast Guard Pharmacy | 18th St and Doughboy Loop Bldg 5660, Troop Medical Health Clinic, Ft Dix, NJ 08640 | 2006-09-22 |
| Find all providers in zip 08640 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669073318 | West New York Healing Center Corp | Clinic/Center | 5300 Bergenline Ave Ste 304, West New York, NJ 07093-5616 | 2020-11-07 |
| 1194354407 | Recover Physical Therapy | Clinic/Center | 1501 Old Black Horse Pike Apt F9, Blackwood, NJ 08012-4927 | 2020-04-07 |
| 1154950657 | Real House Inc. | Clinic/Center | 1089-91 East Jersey Street, Elizabeth, NJ 07201 | 2020-04-06 |
| 1205464823 | Fulcrum Performance Lab, LLC | Clinic/Center | 75 S Maple Ave, Marlton, NJ 08053-2032 | 2020-03-30 |
| 1215563887 | Dr Cloyd's Clinical Psychology and Neuropsychology Practice Pllc | Clinic/Center | 1209 Route 70 W, Cherry Hill, NJ 08002-3532 | 2020-03-16 |
| 1144860271 | Sentarus Healthcare Solutions Inc | Clinic/Center | 736 S White Horse Pike, Audubon, NJ 08106-1346 | 2020-01-07 |
| 1497303044 | Sanni Ojibara Training Academy | Clinic/Center | 104 Hillside Ter, Irvington, NJ 07111-1514 | 2019-08-27 |
| 1457907404 | Vitality Wellness Group LLC | Clinic/Center | 1000 Sanger Ave Ste 211, Oceanport, NJ 07757-1241 | 2019-08-15 |
| 1760034292 | Optimally Nourished LLC | Clinic/Center | 303 Belmont Ave Ste 2, Belleville, NJ 07109-1103 | 2019-07-15 |
| 1881246676 | Acenda, Inc. | Clinic/Center | 1129 Route 9 S, Cape May Court House, NJ 08210-2752 | 2019-07-11 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.