Provider Demographics
NPI:1972600674
Name:CAPOBIANCO, ANTHONY D (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:D
Last Name:CAPOBIANCO
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 1:20 LANDING RD
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2414
Mailing Address - Country:US
Mailing Address - Phone:516-671-5076
Mailing Address - Fax:516-671-5084
Practice Address - Street 1:20 LANDING RD
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2414
Practice Address - Country:US
Practice Address - Phone:516-671-5076
Practice Address - Fax:516-671-5084
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162692-1204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY162692-1OtherMEDICAL LICENSE NUMBER
42945OtherAMER OSTEOPATHIC ASSOC. #
AC3265320OtherDEA #
42945OtherAMER OSTEOPATHIC ASSOC. #
NY45D431Medicare PIN