Provider Demographics
NPI:1801853601
Name:CAPE INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:CAPE INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:STAVE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-465-9980
Mailing Address - Street 1:PO BOX 56
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-0056
Mailing Address - Country:US
Mailing Address - Phone:609-465-9980
Mailing Address - Fax:609-465-9982
Practice Address - Street 1:1 ENTERPRISE DR
Practice Address - Street 2:SUITE A
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-3504
Practice Address - Country:US
Practice Address - Phone:609-465-9980
Practice Address - Fax:609-465-9982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB028872207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1325302Medicaid
NJ110227869OtherRAILROAD MEDICARE
NJ110227869OtherRAILROAD MEDICARE