Provider Demographics
NPI:1063609519
Name:JOHN CAPPA DPM PC
Entity type:Organization
Organization Name:JOHN CAPPA DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPPA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:914-946-9059
Mailing Address - Street 1:309 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1315
Mailing Address - Country:US
Mailing Address - Phone:914-946-9059
Mailing Address - Fax:
Practice Address - Street 1:309 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1315
Practice Address - Country:US
Practice Address - Phone:914-946-9059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004213213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5149830001Medicare NSC
NYPVW821Medicare PIN