Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 199975-1 | NY |
Y | 207Q00000X | Family Doctor | 199975-1 | NY |
NPI | 1578599528 |
---|---|
Provider Name | Dr. Paul James Capobianco |
First Address | Glen Cove, NY 11542-2634 |
Second Address | Glen Cove, NY 11542-2634 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 22/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G15243 | (02) | NY |