Provider Demographics
NPI:1407887508
Name:CAPITAL HEALTH SYSTEM
Entity Type:Organization
Organization Name:CAPITAL HEALTH SYSTEM
Other - Org Name:WEST TRENTON MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP AMBULATORY SERVICES DIVISION
Authorized Official - Prefix:MR
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 784976
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-4976
Mailing Address - Country:US
Mailing Address - Phone:609-815-7810
Mailing Address - Fax:609-815-7814
Practice Address - Street 1:1230 PARKWAY AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:WEST TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08628
Practice Address - Country:US
Practice Address - Phone:609-883-5454
Practice Address - Fax:609-883-2565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0187984Medicaid
NJ102306VH6Medicare PIN
PA106909Medicare PIN
NJ102306Medicare PIN