Provider Demographics
NPI:1457456162
Name:CAPRA, THERESA (PA)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:CAPRA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 WATERS PL
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2700
Mailing Address - Country:US
Mailing Address - Phone:718-829-3440
Mailing Address - Fax:718-828-4899
Practice Address - Street 1:1510 WATERS PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2700
Practice Address - Country:US
Practice Address - Phone:718-829-3440
Practice Address - Fax:718-828-4899
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013134363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT970001984Medicare ID - Type Unspecified
CTQ26517Medicare UPIN