Basic Information
| Provider Information | |||||||||
| NPI: | 1821501735 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAPITAL ORTHOPAEDIC SPECIALISTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 67012 | ||||||||
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| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071018080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015999500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5801 ALLENTOWN RD STE 200 | ||||||||
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| City: | SUITLAND | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207464561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015999500 | ||||||||
| FaxNumber: | 3018567685 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2017 | ||||||||
| LastUpdateDate: | 11/14/2017 | ||||||||
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| AuthorizedOfficialLastName: | BASH | ||||||||
| AuthorizedOfficialFirstName: | CAMILLE | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3015528028 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | D0028936 | MD | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | D0028936 | MD | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 261QP2000X | D0028936 | MD | N | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | 207X00000X | D0028936 | MD | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.