Provider Demographics
NPI:1144270539
Name:PITCHUMONI, CAPECOMORIN S (MD)
Entity type:Individual
Prefix:
First Name:CAPECOMORIN
Middle Name:S
Last Name:PITCHUMONI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 EASTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1766
Mailing Address - Country:US
Mailing Address - Phone:732-745-8600
Mailing Address - Fax:732-745-2980
Practice Address - Street 1:254 EASTON AVE
Practice Address - Street 2:CARES BLDG.
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1766
Practice Address - Country:US
Practice Address - Phone:732-745-8600
Practice Address - Fax:732-745-2980
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA33600207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0005711Medicaid
NJB17849Medicare UPIN
NJ071317B3LMedicare ID - Type Unspecified