Provider Demographics
NPI:1104457993
Name:CAPITALS PIZZERIA
Entity type:Organization
Organization Name:CAPITALS PIZZERIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDULBASIT
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-342-3274
Mailing Address - Street 1:211 REVEREND HOWARD S. WOODSON WAY
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618
Mailing Address - Country:US
Mailing Address - Phone:609-342-3274
Mailing Address - Fax:
Practice Address - Street 1:211 REVEREND HOWARD S. WOODSON WAY
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618
Practice Address - Country:US
Practice Address - Phone:609-342-3274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1255977971Medicaid