Healthcare Provider Details

I. General information

NPI: 1043651110
Provider Name (Legal Business Name): CAPITAL HEALTH CENTER FOR LIVER DISEASE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2013
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CAPITAL WAY SUITE 380
PENNINGTON NJ
08534-2521
US

IV. Provider business mailing address

PO BOX 8500-3372
PHILADELPHIA PA
19178-3372
US

V. Phone/Fax

Practice location:
  • Phone: 609-537-5000
  • Fax: 609-537-5050
Mailing address:
  • Phone: 609-815-7810
  • Fax: 609-815-7814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number25MA08341000
License Number StateNJ

VIII. Authorized Official

Name: SHANE FLEMING
Title or Position: CFO
Credential:
Phone: 609-394-6029