Healthcare Provider Details

I. General information

NPI: 1053608836
Provider Name (Legal Business Name): KRISTIN CAPONE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 FRENCH ST FL 2
NEW BRUNSWICK NJ
08901-1935
US

IV. Provider business mailing address

PO BOX 829642
PHILADELPHIA PA
19182-9642
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-7885
  • Fax:
Mailing address:
  • Phone: 866-470-6626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number25MA10416000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number036138156
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: