Provider Demographics
NPI:1730879354
Name:PAUL CAPOBIANCO, DO, P.A.
Entity type:Organization
Organization Name:PAUL CAPOBIANCO, DO, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CAPOBIANCO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-435-5260
Mailing Address - Street 1:1820 NE JENSEN BEACH BLVD # 512
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-7212
Mailing Address - Country:US
Mailing Address - Phone:516-435-5260
Mailing Address - Fax:
Practice Address - Street 1:3472 NE SAVANNAH RD
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-3758
Practice Address - Country:US
Practice Address - Phone:516-435-5260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty