Provider Demographics
NPI:1073017380
Name:CAPUTO, CATHERINE CAPUTO
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:CAPUTO
Last Name:CAPUTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LOCKSLEY CT
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2608
Mailing Address - Country:US
Mailing Address - Phone:718-554-1042
Mailing Address - Fax:
Practice Address - Street 1:11 MEDICAL DR STE B
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1589
Practice Address - Country:US
Practice Address - Phone:718-554-1042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist