Healthcare Provider Details

I. General information

NPI: 1225049505
Provider Name (Legal Business Name): GERARDO CAPO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 WILLIAMSON ST
ELIZABETH NJ
07202-3625
US

IV. Provider business mailing address

225 WILLIAMSON ST
ELIZABETH NJ
07202-3625
US

V. Phone/Fax

Practice location:
  • Phone: 908-994-5000
  • Fax: 908-994-8744
Mailing address:
  • Phone: 908-994-5000
  • Fax: 908-994-8744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA08098300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number25MA08098300
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number25MA08098300
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA08098300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: