1265679864 NPI number — CAPITAL HEALTH CLINICAL CARDIOLOGY

Table of content: (NPI 1265679864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265679864 NPI number — CAPITAL HEALTH CLINICAL CARDIOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPITAL HEALTH CLINICAL CARDIOLOGY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265679864
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 8500-7761
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19178-7761
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-815-7810
Provider Business Mailing Address Fax Number:
609-737-5914

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2480 PENNINGTON ROAD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
PENNINGTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-737-5911
Provider Business Practice Location Address Fax Number:
609-737-5914
Provider Enumeration Date:
01/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BOSK
Authorized Official First Name:
NATHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
VP AMBULATORY SERVICES DIVISION
Authorized Official Telephone Number:
609-278-5438

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0187496 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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