MEDICARE: MICHAEL CAPICOTTO M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	234826	NY

General Provider Information

NPI Number	:	1366495095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL CAPICOTTO M.D

Provider Business Mailing Address
First Line	:	111 CLOCK TOWER COMMONS
Second Line	:	ROUTE 22
City	:	BREWSTER
State	:	NY
Zip	:	10509-4055
Country	:	US
Telephone Number	:	845-279-5187
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 CLOCK TOWER COMMONS
Second Line	:	ROUTE 22
City	:	BREWSTER
State	:	NY
Zip	:	10509-4055
Country	:	US
Telephone Number	:	845-279-5187
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	02/18/2014

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