Provider Demographics
NPI:1679507792
Name:CAPRIOLI, RUSSELL (DPM)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:
Last Name:CAPRIOLI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580
Mailing Address - Country:US
Mailing Address - Phone:516-568-2319
Mailing Address - Fax:516-568-2318
Practice Address - Street 1:375 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580
Practice Address - Country:US
Practice Address - Phone:516-568-2319
Practice Address - Fax:516-568-2318
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003712213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00869769Medicaid
T32044Medicare UPIN
NY00869769Medicaid