Provider Demographics
NPI:1306947437
Name:CAPO MEDICAL ASSOCIATES PC
Entity type:Organization
Organization Name:CAPO MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:AIDA
Authorized Official - Middle Name:PILAR
Authorized Official - Last Name:CAPO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-861-7900
Mailing Address - Street 1:700 79TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-4965
Mailing Address - Country:US
Mailing Address - Phone:201-861-7900
Mailing Address - Fax:
Practice Address - Street 1:700 79TH ST
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-4965
Practice Address - Country:US
Practice Address - Phone:201-861-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherEIN
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