Healthcare Provider Details

I. General information

NPI: 1629041850
Provider Name (Legal Business Name): ENZA P CAPUTO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 N FRANKLIN BLVD 1ST FLOOR
PLEASANTVILLE NJ
08232-2547
US

IV. Provider business mailing address

22 N FRANKLIN BLVD 2ND FLOOR
PLEASANTVILLE NJ
08232-2547
US

V. Phone/Fax

Practice location:
  • Phone: 609-272-9040
  • Fax: 609-272-9055
Mailing address:
  • Phone: 609-272-0655
  • Fax: 609-272-9317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA06431200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: