MEDICARE: JOHN VITO CAPOTORTO 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	185928	NY

General Provider Information

NPI Number	:	1962406306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN VITO CAPOTORTO M.D.

Provider Business Mailing Address
First Line	:	3311 HYLAN BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306
Country	:	US
Telephone Number	:	718-980-9270
Fax Number	:	718-980-1317

Provider Business Practice Location Address
First Line	:	3311 HYLAN BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306
Country	:	US
Telephone Number	:	718-980-9270
Fax Number	:	718-980-1317

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	10/09/2010

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