Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 211624 | NY |
Y | 207X00000X | Orthopaedic Surgeon | 211624 | NY |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 211624 | NY |
NPI | 1851409627 |
---|---|
Provider Name | Dr. Anthony Cappellino |
First Address | West Babylon, NY 11704-8314 |
Second Address | West Babylon, NY 11704-8314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 18/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200657574 | TAX IDENTIFICATION (01) | NY |
211624 | NYS LICENSE # (01) | NY |