Provider Demographics
NPI:1093196693
Name:CAPUTO, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:CAPUTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 GAIL CT
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10977-6206
Mailing Address - Country:US
Mailing Address - Phone:845-558-0172
Mailing Address - Fax:
Practice Address - Street 1:3 GAIL CT
Practice Address - Street 2:
Practice Address - City:CHESTNUT RIDGE
Practice Address - State:NY
Practice Address - Zip Code:10977-6206
Practice Address - Country:US
Practice Address - Phone:845-558-0172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000020878OtherBOARD OF CERTIFICATION FOR THE ATHLETIC TRAINER