Provider Demographics
NPI:1386713162
Name:NICHOLAS J. CAPUANA, M.D., P.C.
Entity type:Organization
Organization Name:NICHOLAS J. CAPUANA, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAPUANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-733-0451
Mailing Address - Street 1:2 OXFORD XING
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-3236
Mailing Address - Country:US
Mailing Address - Phone:315-733-0451
Mailing Address - Fax:315-733-4435
Practice Address - Street 1:2 OXFORD XING
Practice Address - Street 2:SUITE # 1
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-3236
Practice Address - Country:US
Practice Address - Phone:315-733-0451
Practice Address - Fax:315-733-4435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112705207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00577853Medicaid
NYRB7015Medicare PIN
NYBA1354Medicare PIN
NY00577853Medicaid