Provider Demographics
NPI:1649780479
Name:MIDDLESEX HOSPITAL
Entity type:Organization
Organization Name:MIDDLESEX HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:G
Authorized Official - Last Name:CAPECE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-358-6150
Mailing Address - Street 1:520 SAYBROOK RD STE N100
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4741
Mailing Address - Country:US
Mailing Address - Phone:860-358-6394
Mailing Address - Fax:860-358-6094
Practice Address - Street 1:520 SAYBROOK RD STE N100
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4741
Practice Address - Country:US
Practice Address - Phone:860-344-1801
Practice Address - Fax:860-358-8657
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDDLESEX HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-06
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT207R00000X, 363L00000X, 363LA2100X, 363LF0000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty