Provider Demographics
NPI:1598954158
Name:ANTHONY CAPPELLINO MD PC
Entity Type:Organization
Organization Name:ANTHONY CAPPELLINO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:OFF MGR
Authorized Official - Phone:631-321-0033
Mailing Address - Street 1:60 FLEETS POINT DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-8314
Mailing Address - Country:US
Mailing Address - Phone:631-321-0033
Mailing Address - Fax:631-321-0039
Practice Address - Street 1:60 FLEETS POINT DR
Practice Address - Street 2:SUITE 1
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-8314
Practice Address - Country:US
Practice Address - Phone:631-321-0033
Practice Address - Fax:631-321-0039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211624NY207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty