Provider Demographics
NPI:1902903099
Name:CAPOBIANCO, LUIGI M (MD)
Entity Type:Individual
Prefix:
First Name:LUIGI
Middle Name:M
Last Name:CAPOBIANCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:972 BRUSH HOLLOW RD
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-1740
Mailing Address - Country:US
Mailing Address - Phone:516-876-5555
Mailing Address - Fax:516-876-5539
Practice Address - Street 1:1 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2545
Practice Address - Country:US
Practice Address - Phone:516-671-9800
Practice Address - Fax:516-671-9283
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY174738207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01463932Medicaid
NY27E271Medicare ID - Type Unspecified
A61756Medicare UPIN
NY01463932Medicaid