Provider Demographics
NPI:1902157654
Name:ABESAMIS-CAPILI, THERESE
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:
Last Name:ABESAMIS-CAPILI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 BARTHOLDI AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-1857
Mailing Address - Country:US
Mailing Address - Phone:201-275-6454
Mailing Address - Fax:
Practice Address - Street 1:239 BARTHOLDI AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-1857
Practice Address - Country:US
Practice Address - Phone:201-275-6454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program