Provider Demographics
NPI:1205868056
Name:COURT HOUSE INTERNAL MEDICINE P.C.
Entity Type:Organization
Organization Name:COURT HOUSE INTERNAL MEDICINE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDELL
Authorized Official - Middle Name:A
Authorized Official - Last Name:NUSCHKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-465-2710
Mailing Address - Street 1:9 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-1937
Mailing Address - Country:US
Mailing Address - Phone:609-465-2710
Mailing Address - Fax:609-463-8135
Practice Address - Street 1:9 BROADWAY
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-1937
Practice Address - Country:US
Practice Address - Phone:609-465-2710
Practice Address - Fax:609-465-8135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I8257OtherRAILROAD MEDICARE
1079811OtherHORIZON NJ HEALTH
520509OtherAETNA OFFICE #3368
9661661OtherGHI
0516358001OtherAMERIHEALTH
22360250OtherTAX ID#
NJ7765908Medicaid
=========OtherHEALTH NET
=========OtherCHAMPUS
=========OtherCHOICECARE HUMANA
I8257OtherRAILROAD MEDICARE
NJ7765908Medicaid
9661661OtherGHI
=========OtherPHCS PRIVATE HEALTHCARE
=========OtherOXFORD
=========OtherMULTIPLAN
=========OtherFIRST HEALTH
=========OtherUNITED HEALTHCARE
=========OtherDEVON
=========OtherHNA HEALTH NETWORK AMER