MEDICARE: MR. JOSEPH GERARD CAPPELLANO CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	005498-1	NY

General Provider Information

NPI Number	:	1083912356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH GERARD CAPPELLANO CCC-SLP

Provider Business Mailing Address
First Line	:	10000 BEACH CHANNEL DR
Second Line	:
City	:	ROCKAWAY PARK
State	:	NY
Zip	:	11694-2818
Country	:	US
Telephone Number	:	718-945-6900
Fax Number	:	718-945-0557

Provider Business Practice Location Address
First Line	:	10000 BEACH CHANNEL DR
Second Line	:
City	:	ROCKAWAY PARK
State	:	NY
Zip	:	11694-2818
Country	:	US
Telephone Number	:	718-945-6900
Fax Number	:	718-945-0557

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2011
Last Update Date	:	03/10/2011

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Directions to “ MR. JOSEPH GERARD CAPPELLANO CCC-SLP” Practice Location

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