Provider Demographics
NPI:1447203237
Name:CAPPELLO, RENATO M (DC)
Entity Type:Individual
Prefix:
First Name:RENATO
Middle Name:M
Last Name:CAPPELLO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-1402
Mailing Address - Country:US
Mailing Address - Phone:973-672-7246
Mailing Address - Fax:
Practice Address - Street 1:633 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1402
Practice Address - Country:US
Practice Address - Phone:973-672-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYXO11114-1111N00000X
NJ38MC00643000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02711984Medicaid
NY02711984Medicaid
NYX03M61Medicare PIN