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General NPI Number Information
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NPI Number | 1043651110
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Entity Type | Organization
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Legal Business Name | CAPITAL HEALTH CENTER FOR LIVER DISEASE
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Dates
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Enumeration Date | 07/17/2013
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Last Update Date | 07/17/2013
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Provider Practice Location Address
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Address Line | 2 CAPITAL WAY SUITE 380
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City | PENNINGTON
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State | NJ
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Zip | 08534-2521
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Country | US
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Telephone | 609-537-5000
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Fax | 609-537-5050
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Provider Business Mailing Address
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Address Line | PO BOX 8500-3372
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City | PHILADELPHIA
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State | PA
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Zip | 19178-3372
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Country | US
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Telephone | 609-815-7810
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Fax | 609-815-7814
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Authorized Official
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Title or Position | CFO
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Name | SHANE FLEMING
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Credential |
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Telephone | 609-394-6029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0008X
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Taxonomy Name | Hepatology Physician
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License Number | 25MA08341000
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License Number State | NJ
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