Provider Demographics
NPI:1144421553
Name:CAPONE, DOMINIC JAMES (MS, PT)
Entity Type:Individual
Prefix:MR
First Name:DOMINIC
Middle Name:JAMES
Last Name:CAPONE
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 CLOCK TOWER COMMONS
Mailing Address - Street 2:ROUTE 22
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-4057
Mailing Address - Country:US
Mailing Address - Phone:845-278-4127
Mailing Address - Fax:845-278-4128
Practice Address - Street 1:211 CLOCK TOWER COMMONS
Practice Address - Street 2:ROUTE 22
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-4057
Practice Address - Country:US
Practice Address - Phone:845-278-4127
Practice Address - Fax:845-278-4128
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008679174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ56831OtherBLUE CROSS BLUE SHIELD
NYA494970OtherOXFORD
NYQ56831OtherBLUE CROSS BLUE SHIELD
NYA494970OtherOXFORD