Provider Demographics
NPI:1316044571
Name:JAMES R. CAPUTO M.D.P.C.
Entity Type:Organization
Organization Name:JAMES R. CAPUTO M.D.P.C.
Other - Org Name:THE GOOD LIFE CENTRE FOR WOMEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:CAPUTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-475-8599
Mailing Address - Street 1:739 IRVING AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1640
Mailing Address - Country:US
Mailing Address - Phone:315-475-8599
Mailing Address - Fax:315-475-8577
Practice Address - Street 1:739 IRVING AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1640
Practice Address - Country:US
Practice Address - Phone:315-475-8599
Practice Address - Fax:315-475-8577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206065-1261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01766036Medicaid
AA0537Medicare PIN
NY01766036Medicaid