1760774954 NPI number — CAPITAL HEALTH CENTER FOR DIGESTIVE HEALTH

Table of content: (NPI 1760774954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760774954 NPI number — CAPITAL HEALTH CENTER FOR DIGESTIVE HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPITAL HEALTH CENTER FOR DIGESTIVE HEALTH
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:
1760774954
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8500-8862
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:
19178-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-394-6273
Provider Business Mailing Address Fax Number:
609-394-6681

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 BEAR TAVERN RD
Provider Second Line Business Practice Location Address:
SUITE 309
Provider Business Practice Location Address City Name:
EWING
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08628-1018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-394-6211
Provider Business Practice Location Address Fax Number:
609-278-5469
Provider Enumeration Date:
05/06/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GUY
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
609-394-6273

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  25MA0849800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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