Provider Demographics
NPI:1639719248
Name:CAPISTRANO, SIEGFREID (DPT)
Entity Type:Individual
Prefix:
First Name:SIEGFREID
Middle Name:
Last Name:CAPISTRANO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1646 BRENTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-5534
Mailing Address - Country:US
Mailing Address - Phone:631-231-5200
Mailing Address - Fax:
Practice Address - Street 1:1646 BRENTWOOD RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-5534
Practice Address - Country:US
Practice Address - Phone:631-231-5200
Practice Address - Fax:631-231-4431
Is Sole Proprietor?:No
Enumeration Date:2020-01-11
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026839225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist