Provider Demographics
NPI:1932823044
Name:CAPERS, CATHY (DSP)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:CAPERS
Suffix:
Gender:F
Credentials:DSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 GOVERNOR ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07501-1213
Mailing Address - Country:US
Mailing Address - Phone:862-271-3605
Mailing Address - Fax:
Practice Address - Street 1:125 GOVERNOR ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-1213
Practice Address - Country:US
Practice Address - Phone:862-271-3605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0450865082Medicaid