Provider Demographics
NPI:1679635965
Name:CAPAN, LEVON MISAK (MD)
Entity Type:Individual
Prefix:DR
First Name:LEVON
Middle Name:MISAK
Last Name:CAPAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 DYER CT
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07648-2308
Mailing Address - Country:US
Mailing Address - Phone:201-767-4066
Mailing Address - Fax:
Practice Address - Street 1:462 1ST AVE
Practice Address - Street 2:NB 11N34
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9196
Practice Address - Country:US
Practice Address - Phone:212-523-6571
Practice Address - Fax:212-263-8743
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122150207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02113000Medicaid
NY02113000Medicaid
NY693661Medicare ID - Type Unspecified