Provider Demographics
NPI:1184834400
Name:MARTINEZ-CAPOLINO, CYNTHIA CHRISTINE (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:CHRISTINE
Last Name:MARTINEZ-CAPOLINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 DRIVING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1057
Mailing Address - Country:US
Mailing Address - Phone:315-332-2290
Mailing Address - Fax:
Practice Address - Street 1:1250 DRIVING PARK AVENUE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513
Practice Address - Country:US
Practice Address - Phone:315-332-2290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301081762207P00000X
NY257830207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY60 257830OtherNYS DEPARTMENT OF HEALTH
NY03264826Medicaid
NY60 257830OtherNYS DEPARTMENT OF HEALTH
NY03264826Medicaid