Provider Demographics
NPI:1790174779
Name:CAPSTONE HEALTH GROUP
Entity Type:Organization
Organization Name:CAPSTONE HEALTH GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUISH
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:973-808-5551
Mailing Address - Street 1:1225 MCBRIDE AVE
Mailing Address - Street 2:SUITE 222
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-3812
Mailing Address - Country:US
Mailing Address - Phone:973-808-5551
Mailing Address - Fax:973-808-5999
Practice Address - Street 1:1225 MCBRIDE AVE
Practice Address - Street 2:SUITE 222
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424-3812
Practice Address - Country:US
Practice Address - Phone:973-808-5551
Practice Address - Fax:973-808-5999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09116700174400000X
NJ26NJ00279300174400000X
NJ26NN10630000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty