Provider Demographics
NPI:1780632125
Name:CAPASSE, JEANNE SCHNOG (MD)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:SCHNOG
Last Name:CAPASSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 EAST AVE
Mailing Address - Street 2:SUITE 2L
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5721
Mailing Address - Country:US
Mailing Address - Phone:203-846-8885
Mailing Address - Fax:203-846-6032
Practice Address - Street 1:148 EAST AVE
Practice Address - Street 2:SUITE 2L
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5721
Practice Address - Country:US
Practice Address - Phone:203-846-8885
Practice Address - Fax:203-846-6032
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT034372208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001343722Medicaid
F71525Medicare UPIN
020001240Medicare ID - Type Unspecified