Basic Information
| Provider Information | |||||||||
| NPI: | 1235484650 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAPITAL INSTITUTE FOR NEUROSCIENCES CENTER FOR NEURO-ONCOLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8500-6977 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191780001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098157810 | ||||||||
| FaxNumber: | 6098157814 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 CAPITAL WAY | ||||||||
| Address2: | SUITE 456 | ||||||||
| City: | PENNINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085342521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095377300 | ||||||||
| FaxNumber: | 6095377301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2012 | ||||||||
| LastUpdateDate: | 07/23/2012 | ||||||||
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| AuthorizedOfficialLastName: | FLEMING | ||||||||
| AuthorizedOfficialFirstName: | SHANE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6093946029 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.