Healthcare Provider Details

I. General information

NPI: 1760774954
Provider Name (Legal Business Name): CAPITAL HEALTH CENTER FOR DIGESTIVE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2011
Last Update Date: 05/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 BEAR TAVERN RD SUITE 309
EWING NJ
08628-1018
US

IV. Provider business mailing address

PO BOX 8500-8862
PHILADELPHIA PA
19178-0001
US

V. Phone/Fax

Practice location:
  • Phone: 609-394-6211
  • Fax: 609-278-5469
Mailing address:
  • Phone: 609-394-6273
  • Fax: 609-394-6681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA0849800
License Number StateNJ

VIII. Authorized Official

Name: RONALD J GUY
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 609-394-6273