Healthcare Provider Details

I. General information

NPI: 1003515834
Provider Name (Legal Business Name): NICOLE CAPONE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 SUNRISE HWY
MASSAPEQUA NY
11758-5303
US

IV. Provider business mailing address

4 GEORGIA PINE PL
MEDFORD NY
11763-4108
US

V. Phone/Fax

Practice location:
  • Phone: 516-393-1000
  • Fax:
Mailing address:
  • Phone: 516-233-9141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number421899
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: