Provider Demographics
NPI:1043651110
Name:CAPITAL HEALTH CENTER FOR LIVER DISEASE
Entity type:Organization
Organization Name:CAPITAL HEALTH CENTER FOR LIVER DISEASE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-394-6029
Mailing Address - Street 1:PO BOX 8500-3372
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3372
Mailing Address - Country:US
Mailing Address - Phone:609-815-7810
Mailing Address - Fax:609-815-7814
Practice Address - Street 1:2 CAPITAL WAY
Practice Address - Street 2:SUITE 380
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-2521
Practice Address - Country:US
Practice Address - Phone:609-537-5000
Practice Address - Fax:609-537-5050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08341000207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatologyGroup - Single Specialty