Provider Demographics
NPI:1013108190
Name:CAPITAL HEALTH SYSTEM
Entity Type:Organization
Organization Name:CAPITAL HEALTH SYSTEM
Other - Org Name:INSTITUTE FOR NEUROSCIENCES
Other - Org Type:Doing Business As
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:PO BOX 8500-9956
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-9956
Mailing Address - Country:US
Mailing Address - Phone:609-815-7810
Mailing Address - Fax:609-815-7814
Practice Address - Street 1:1401 WHITEHORSE MERCERVILLE ROAD
Practice Address - Street 2:SUITE 216
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-3817
Practice Address - Country:US
Practice Address - Phone:609-528-8888
Practice Address - Fax:609-584-5151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA050235002081H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4013409Medicaid
NJ117935Medicare PIN