Healthcare Provider Details

I. General information

NPI: 1386627321
Provider Name (Legal Business Name): EDNA KAPENHAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EDNA KAPENHAS-VALDES MD

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 11/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 MEETING HOUSE LN
SOUTHAMPTON NY
11968-5009
US

IV. Provider business mailing address

PO BOX 2340
SOUTHAMPTON NY
11969-2340
US

V. Phone/Fax

Practice location:
  • Phone: 631-726-8300
  • Fax:
Mailing address:
  • Phone: 631-283-2430
  • Fax: 631-283-5731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number231215
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: