Healthcare Provider Details

I. General information

NPI: 1578599528
Provider Name (Legal Business Name): PAUL JAMES CAPOBIANCO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 03/20/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3472 NE SAVANNAH RD.
JENSEN BEACH FL
34957
US

IV. Provider business mailing address

1820 NE JENSEN BEACH BLVD # 512
JENSEN BEACH FL
34957-7212
US

V. Phone/Fax

Practice location:
  • Phone: 516-435-5260
  • Fax:
Mailing address:
  • Phone: 516-435-5260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number199975-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS16010
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number199975-1
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberOS16010
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: