Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 182685-1 | NY |
Y | 207Q00000X | Family Doctor | 182685-1 | NY |
N | 208D00000X | General Practice Physician | 182685-1 | NY |
NPI | 1245267970 |
---|---|
Provider Name | John David Capobianco |
First Address | Sea Cliff, NY 11579-2121 |
Second Address | Glen Cove, NY 11542-2414 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 06/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
55F331 | (02) | NY |
F33281 | (02) | NY |