Healthcare Provider Details

I. General information

NPI: 1659338564
Provider Name (Legal Business Name): JOHN JOSEPH CAPONIGRO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3074 31ST ST FL 6
ASTORIA NY
11102-2073
US

IV. Provider business mailing address

3074 31ST ST FL 6
ASTORIA NY
11102-2073
US

V. Phone/Fax

Practice location:
  • Phone: 718-545-3668
  • Fax: 718-301-6877
Mailing address:
  • Phone: 718-545-3668
  • Fax: 718-301-6877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberMD002533
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN005400
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: