Healthcare Provider Details

I. General information

NPI: 1912985227
Provider Name (Legal Business Name): DOMINIC CAPPELLERI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 01/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 PULASKI HWY HUDSON RIVER HEALTHCARE, INC.
GOSHEN NY
10924-6034
US

IV. Provider business mailing address

1037 MAIN ST HUDSON RIVER HEALTHCARE, INC.
PEEKSKILL NY
10566-2913
US

V. Phone/Fax

Practice location:
  • Phone: 845-651-2298
  • Fax: 845-651-2299
Mailing address:
  • Phone: 914-734-8800
  • Fax: 845-651-2299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number113179
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number113179
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: