Provider Demographics
NPI:1265679864
Name:CAPITAL HEALTH CLINICAL CARDIOLOGY
Entity Type:Organization
Organization Name:CAPITAL HEALTH CLINICAL CARDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP AMBULATORY SERVICES DIVISION
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-278-5438
Mailing Address - Street 1:P.O. BOX 8500-7761
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-7761
Mailing Address - Country:US
Mailing Address - Phone:609-815-7810
Mailing Address - Fax:609-737-5914
Practice Address - Street 1:2480 PENNINGTON ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534
Practice Address - Country:US
Practice Address - Phone:609-737-5911
Practice Address - Fax:609-737-5914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-20
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0187496Medicaid
NJ147013ZCISMedicare PIN