Provider Demographics
NPI:1659170918
Name:CAPOZZOLI, GERALD ROBERT JR
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:ROBERT
Last Name:CAPOZZOLI
Suffix:JR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2541 WHITE MOUNTAIN HWY STE 5
Mailing Address - Street 2:
Mailing Address - City:NORTH CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03860-5125
Mailing Address - Country:US
Mailing Address - Phone:603-506-4055
Mailing Address - Fax:
Practice Address - Street 1:2541 WHITE MOUNTAIN HWY STE 5
Practice Address - Street 2:
Practice Address - City:NORTH CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03860-5125
Practice Address - Country:US
Practice Address - Phone:603-506-4055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2072237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist