Healthcare Provider Details

I. General information

NPI: 1851715221
Provider Name (Legal Business Name): CAPCOR NEURODIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2014
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 KELLOGG RD
NEW HARTFORD NY
13413-2825
US

IV. Provider business mailing address

14 KELLOGG RD
NEW HARTFORD NY
13413-2825
US

V. Phone/Fax

Practice location:
  • Phone: 315-542-2782
  • Fax:
Mailing address:
  • Phone: 315-542-2782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084D0003X
TaxonomyDiagnostic Neuroimaging (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: SALVATORE CAPUANA
Title or Position: GENERAL PARTNER
Credential: DC
Phone: 315-542-2782