Provider Demographics
NPI:1225355548
Name:EDDY CAPOTE JR. MD PC
Entity Type:Organization
Organization Name:EDDY CAPOTE JR. MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPOTE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:716-713-1433
Mailing Address - Street 1:13105 CENTERLINE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH WALES
Mailing Address - State:NY
Mailing Address - Zip Code:14139-9764
Mailing Address - Country:US
Mailing Address - Phone:716-713-1433
Mailing Address - Fax:
Practice Address - Street 1:13105 CENTERLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTH WALES
Practice Address - State:NY
Practice Address - Zip Code:14139-9764
Practice Address - Country:US
Practice Address - Phone:716-713-1433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251634207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1598902082OtherINDIVIDUAL NPI