Provider Demographics
NPI:1376003665
Name:DI CAPUA, JOHN FEDERICO JR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:FEDERICO
Last Name:DI CAPUA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8025 BLACK HORSE PIKE STE 300
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-2962
Mailing Address - Country:US
Mailing Address - Phone:609-652-8316
Mailing Address - Fax:
Practice Address - Street 1:44 E JIMMIE LEEDS RD STE 101
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9599
Practice Address - Country:US
Practice Address - Phone:609-677-9729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-22
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MA126165002085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program