=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376773218
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAPITAL CARE ASSOCIATES PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2009
-----------------------------------------------------
Last Update Date | 07/24/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 750 BRUNSWICK AVE
-----------------------------------------------------
City | TRENTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-834-8693
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1977 N OLDEN AVE EXTENSION 285
-----------------------------------------------------
City | TRENTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | ANASSE SOUIDI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-834-8693
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 25MA08448200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------