Healthcare Provider Details

I. General information

NPI: 1881824340
Provider Name (Legal Business Name): ANTHONY A CAPACCIO RPAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2009
Last Update Date: 07/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BROAD ST
HAMILTON NY
13346-9575
US

IV. Provider business mailing address

PO BOX 317
HAMILTON NY
13346-0317
US

V. Phone/Fax

Practice location:
  • Phone: 315-824-1100
  • Fax:
Mailing address:
  • Phone: 315-824-6652
  • Fax: 315-824-6544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number000301
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: