Healthcare Provider Details

I. General information

NPI: 1194842187
Provider Name (Legal Business Name): ERIN E CAPO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 12/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27005 76TH AVE
NEW HYDE PARK NY
11040-1433
US

IV. Provider business mailing address

27005 76TH AVE
NEW HYDE PARK NY
11040-1433
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-7232
  • Fax: 718-343-7463
Mailing address:
  • Phone: 718-470-7177
  • Fax: 718-343-7463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number010539
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: