1386781284 NPI number — LUCIE CAPEK, MD, PLLC

Table of content: (NPI 1386781284)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386781284 NPI number — LUCIE CAPEK, MD, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUCIE CAPEK, MD, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386781284
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
713 TROY SCHENECTADY RD
Provider Second Line Business Mailing Address:
SUITE 308
Provider Business Mailing Address City Name:
LATHAM
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12110-2490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-786-1700
Provider Business Mailing Address Fax Number:
518-786-9241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
713 TROY SCHENECTADY RD
Provider Second Line Business Practice Location Address:
SUITE 308
Provider Business Practice Location Address City Name:
LATHAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12110-2490
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-786-1700
Provider Business Practice Location Address Fax Number:
518-783-9241
Provider Enumeration Date:
01/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CAPEK
Authorized Official First Name:
LUCIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
518-786-1700

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  204519 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DG2474 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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