Provider Demographics
NPI:1275524043
Name:CAPORALE, ELAINA M (PA-C)
Entity Type:Individual
Prefix:
First Name:ELAINA
Middle Name:M
Last Name:CAPORALE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELAINA
Other - Middle Name:M
Other - Last Name:MASTRANGELO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1099 TARGEE ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4310
Mailing Address - Country:US
Mailing Address - Phone:718-448-3210
Mailing Address - Fax:718-442-9085
Practice Address - Street 1:1099 TARGEE ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4310
Practice Address - Country:US
Practice Address - Phone:718-448-3210
Practice Address - Fax:718-442-9085
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0097761363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q29668Medicare UPIN
NY5699L1Medicare ID - Type Unspecified