=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487003687
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CNS OCCUPATIONAL MEDICINE OF DELAWARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2016
-----------------------------------------------------
Last Update Date | 02/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20797 PROFESSIONAL PARK BLVD
-----------------------------------------------------
City | GEORGETOWN
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19947-3198
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-515-1708
-----------------------------------------------------
Fax | 302-947-4433
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20797 PROFESSIONAL PARK BLVD
-----------------------------------------------------
City | GEORGETOWN
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19947-3198
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-515-1708
-----------------------------------------------------
Fax | 302-947-4433
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | JOHN IRWIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 302-515-1708
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QX0100X
-----------------------------------------------------
Taxonomy Name | Occupational Medicine Clinic/Center
-----------------------------------------------------
License Number | C10004408
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------