Provider Demographics
NPI:1215399043
Name:ROSE R CAPUZ
Entity Type:Organization
Organization Name:ROSE R CAPUZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CAPUZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:917-743-0542
Mailing Address - Street 1:122 ST NICHOLAS AVENUE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237
Mailing Address - Country:US
Mailing Address - Phone:917-743-0542
Mailing Address - Fax:347-689-8136
Practice Address - Street 1:122 ST NICHOLAS AVENUE
Practice Address - Street 2:SUITE 2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237
Practice Address - Country:US
Practice Address - Phone:917-743-0542
Practice Address - Fax:347-689-8136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY276507-13140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric