MEDICARE: EDDY CAPOTE JR. MD PC

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	207QA0505X	Adult Medicine Physician	251634	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1598902082	OTHER	NY	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1225355548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDDY CAPOTE JR. MD PC

Provider Business Mailing Address
First Line	:	13105 CENTERLINE RD
Second Line	:
City	:	SOUTH WALES
State	:	NY
Zip	:	14139-9764
Country	:	US
Telephone Number	:	716-713-1433
Fax Number	:

Provider Business Practice Location Address
First Line	:	13105 CENTERLINE RD
Second Line	:
City	:	SOUTH WALES
State	:	NY
Zip	:	14139-9764
Country	:	US
Telephone Number	:	716-713-1433
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. EDDY CAPOTE JR.
Credential	:	MD
Telephone Number	:	716-713-1433

Provider Enumeration Date	:	04/26/2010
Last Update Date	:	04/26/2010

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