Provider Demographics
NPI:1770676819
Name:MINACAPILLI, CHRISTOPHER M (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:M
Last Name:MINACAPILLI
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 1:65 JUMEL ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-1720
Mailing Address - Country:US
Mailing Address - Phone:718-541-7017
Mailing Address - Fax:
Practice Address - Street 1:33 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4338
Practice Address - Country:US
Practice Address - Phone:212-473-3049
Practice Address - Fax:212-777-3347
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006072213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02678504Medicaid
NY8472890OtherCIGNA
NYPJ922OtherEMPIRE BLUE CROSS BLUE SH
NYPJ922OtherEMPIRE BLUE CROSS BLUE SH
NY02678504Medicaid