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General NPI Number Information
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NPI Number | 1295197283
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Entity Type | Individual
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Provider Name | KATHLEEN MARY CAPACCIONE M.D., PH.D.
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Gender | Female
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Dates
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Enumeration Date | 03/28/2016
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Last Update Date | 05/05/2022
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Provider Practice Location Address
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Address Line | 722 W 168TH STREET PRESBYTERIAN BUILDING 1-301
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City | NEW YORK
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State | NY
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Zip | 10032
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Country | US
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Telephone | 212-305-9024
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Fax |
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Provider Business Mailing Address
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Address Line | 46 GRAND ST
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City | LITTLE FERRY
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State | NJ
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Zip | 07643-1507
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Country | US
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Telephone | 908-672-6160
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 293618
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License Number State | NY
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