Basic Information
| Provider Information | |||||||||
| NPI: | 1548348766 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAPILUPI | ||||||||
| FirstName: | THOMAS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 68 S SERVICE RD | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | MELVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117472354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5169453000 | ||||||||
| FaxNumber: | 5169453131 | ||||||||
| Practice Location | |||||||||
| Address1: | 1171 OLD COUNTRY RD | ||||||||
| Address2: | |||||||||
| City: | PLAINVIEW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 118035022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5169314343 | ||||||||
| FaxNumber: | 5169310347 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 11/12/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 173000000X | 177426 | NY | Y | Other Service Providers | Legal Medicine | 208000000X | 177426 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 01192543 | 05 | NY | MEDICAID |