=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902803414
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BARBARA KAPUSCINSKA MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2005
-----------------------------------------------------
Last Update Date | 02/09/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7 SOUTHWOODS BLVD CAPITAL CARDIOLOGY ASSOCIATES, PC
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12211-2526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-292-6000
-----------------------------------------------------
Fax | 518-292-6050
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 BELL TOWER DR CAPITAL CARDIOLOGY ASSOCIATES, PC
-----------------------------------------------------
City | WATERVLIET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12189-2333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-268-6390
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 173869
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------