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NPI Code Detail

MEDICARE: ANTHONY CAPPADORA P.A.

MEDICARE: ANTHONY CAPPADORA P.A.
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
1363A00000XPhysician Assistant017895NY

General Provider Information

NPI Number : 1891195731
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTHONY CAPPADORA P.A.
Provider Business Mailing Address
First Line : 161 MARILYNN ST
Second Line :
City : EAST ISLIP
State : NY
Zip : 11730-3311
Country : US
Telephone Number : 631-521-4382
Fax Number :
Provider Business Practice Location Address
First Line : 57190 MAIN RD
Second Line :
City : SOUTHOLD
State : NY
Zip : 11971-4750
Country : US
Telephone Number : 631-626-1006
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2014
Last Update Date : 08/11/2021

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