Basic Information
Provider Information
NPI: 1124373485
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CAPASSO
FirstName: DONNA
MiddleName: ELIZABETH
NamePrefix: MRS.
NameSuffix:  
Credential: P.A.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1345 RXR PLZ
Address2:  
City: UNIONDALE
State: NY
PostalCode: 115561301
CountryCode: US
TelephoneNumber: 5164530435
FaxNumber:  
Practice Location
Address1: 2459 MERRICK RD
Address2:  
City: BELLMORE
State: NY
PostalCode: 117105703
CountryCode: US
TelephoneNumber: 5168262273
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/23/2012
LastUpdateDate: 07/23/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X004475NYY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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