Healthcare Provider Details

I. General information

NPI: 1851409627
Provider Name (Legal Business Name): ANTHONY CAPPELLINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 03/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 631-689-6698
  • Fax: 631-751-5548
Mailing address:
  • Phone: 631-689-6698
  • Fax: 631-751-5548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number211624
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number211624
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number211624
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: