Provider Demographics
NPI:1912985227
Name:CAPPELLERI, DOMINIC (MD)
Entity type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:
Last Name:CAPPELLERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 MAIN ST
Mailing Address - Street 2:HUDSON RIVER HEALTHCARE, INC.
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2913
Mailing Address - Country:US
Mailing Address - Phone:914-734-8800
Mailing Address - Fax:845-651-2299
Practice Address - Street 1:888 PULASKI HWY
Practice Address - Street 2:HUDSON RIVER HEALTHCARE, INC.
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-6034
Practice Address - Country:US
Practice Address - Phone:845-651-2298
Practice Address - Fax:845-651-2299
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113179207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00537962Medicaid
NY00537962Medicaid
NYA400075091Medicare PIN