Provider Demographics
NPI:1114054483
Name:CAPONEGRO UROLOGICAL ASSOCIATES MDPC
Entity Type:Organization
Organization Name:CAPONEGRO UROLOGICAL ASSOCIATES MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CAPONEGRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-497-3503
Mailing Address - Street 1:734 FRANKLIN AVE
Mailing Address - Street 2:#231
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4525
Mailing Address - Country:US
Mailing Address - Phone:516-326-2235
Mailing Address - Fax:
Practice Address - Street 1:6810 FOREST AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-4468
Practice Address - Country:US
Practice Address - Phone:718-497-3503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY083391-1208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
33334Medicare ID - Type Unspecified
B88577Medicare UPIN