Provider Demographics
NPI:1235196049
Name:KAPETANAKIS, DEAN (PT)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:KAPETANAKIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WALTER FORAN BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-4664
Mailing Address - Country:US
Mailing Address - Phone:908-237-0000
Mailing Address - Fax:908-237-0001
Practice Address - Street 1:60 WALNUT AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1649
Practice Address - Country:US
Practice Address - Phone:732-340-1012
Practice Address - Fax:908-237-0001
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00755100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ035684TBDMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE#