Healthcare Provider Details

I. General information

NPI: 1598954158
Provider Name (Legal Business Name): ANTHONY CAPPELLINO MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 05/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 FLEETS POINT DR SUITE 1
WEST BABYLON NY
11704-8314
US

IV. Provider business mailing address

60 FLEETS POINT DR SUITE 1
WEST BABYLON NY
11704-8314
US

V. Phone/Fax

Practice location:
  • Phone: 631-321-0033
  • Fax: 631-321-0039
Mailing address:
  • Phone: 631-321-0033
  • Fax: 631-321-0039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number211624NY
License Number StateNY

VIII. Authorized Official

Name: MRS. BARBARA HARRIS
Title or Position: OFFICE MANAGER
Credential: OFF. MGR
Phone: 631-321-0033