Healthcare Provider Details

I. General information

NPI: 1487003687
Provider Name (Legal Business Name): CNS OCCUPATIONAL MEDICINE OF DELAWARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20797 PROFESSIONAL PARK BLVD
GEORGETOWN DE
19947-3198
US

IV. Provider business mailing address

20797 PROFESSIONAL PARK BLVD
GEORGETOWN DE
19947-3198
US

V. Phone/Fax

Practice location:
  • Phone: 302-515-1708
  • Fax: 302-947-4433
Mailing address:
  • Phone: 302-515-1708
  • Fax: 302-947-4433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License NumberC10004408
License Number StateDE

VIII. Authorized Official

Name: JOHN IRWIN
Title or Position: CEO
Credential:
Phone: 302-515-1708