Healthcare Provider Details

I. General information

NPI: 1043530298
Provider Name (Legal Business Name): MS. STEPHANIE CAPONE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 5TH AVE
HASKELL NJ
07420-1075
US

IV. Provider business mailing address

25 5TH AVE
HASKELL NJ
07420-1075
US

V. Phone/Fax

Practice location:
  • Phone: 973-835-0895
  • Fax:
Mailing address:
  • Phone: 973-835-0895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: