Provider Demographics
NPI:1912117144
Name:CAPOBIANCO, VICTORIA VADALA (DO)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:VADALA
Last Name:CAPOBIANCO
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:65 SCUDDERS LN
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-1535
Mailing Address - Country:US
Mailing Address - Phone:516-801-1494
Mailing Address - Fax:
Practice Address - Street 1:333 GLEN HEAD RD STE 202
Practice Address - Street 2:
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545-1947
Practice Address - Country:US
Practice Address - Phone:516-672-8115
Practice Address - Fax:516-672-8115
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2484382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry