Healthcare Provider Details

I. General information

NPI: 1043224009
Provider Name (Legal Business Name): JOSHUA CAPPELL MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 01/24/2023
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVENUE WFAN - 3RD FL ROOM PC338
HACKENSACK NJ
07601
US

IV. Provider business mailing address

30 PROSPECT AVE
HACKENSACK NJ
07601-1915
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-3200
  • Fax: 201-968-0163
Mailing address:
  • Phone: 551-996-3200
  • Fax: 201-968-0163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number215067
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number215067-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number25MA11054200
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier02621709
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 2
Identifier0118826
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: