OrganizationActive
Src Pending Consult Management
NPI 1366433534 · Clinic/Center · Fort Dix, NJ
Provider details
- NPI number
- 1366433534
- Entity type
- Organization
- Primary specialty
- Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Christala Cherry, Case Manager(609) 562-6312
- License
- 26NR09534400 (NJ)
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
Detailed profile(91/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
20 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
5250 Maryland Ave
Fort Dix, NJ 08640-5058
Phone: (609) 562-6312
Street-level locationGet directions
Mailing address
1312 Paris Ct
Lakewood, NJ 08701-3724
Registry dates
- Enumerated
- 2005-11-04
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.