Provider Demographics
NPI:1235190935
Name:CAPUTO, PATRICK J (DPM)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:CAPUTO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 N BEERS ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1522
Mailing Address - Country:US
Mailing Address - Phone:732-739-3230
Mailing Address - Fax:732-739-4656
Practice Address - Street 1:719 N BEERS ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1522
Practice Address - Country:US
Practice Address - Phone:732-739-3230
Practice Address - Fax:732-739-4656
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01463213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT45431Medicare UPIN
NJ454898Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID#