Provider Demographics
NPI:1336232388
Name:CAPUANO KING, CECILIA (DPM)
Entity Type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:
Last Name:CAPUANO KING
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 ROUTE 111
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3712
Mailing Address - Country:US
Mailing Address - Phone:631-406-7778
Mailing Address - Fax:631-724-0323
Practice Address - Street 1:61 ROUTE 111
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3712
Practice Address - Country:US
Practice Address - Phone:631-406-7778
Practice Address - Fax:631-724-0323
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005857213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU90953Medicare UPIN
NYPG8492Medicare ID - Type Unspecified