Provider Demographics
NPI:1871697912
Name:CAPOGNA, LORETO (DPM)
Entity type:Individual
Prefix:DR
First Name:LORETO
Middle Name:
Last Name:CAPOGNA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ADMIRAL RD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-7814
Mailing Address - Country:US
Mailing Address - Phone:516-541-1360
Mailing Address - Fax:516-882-2133
Practice Address - Street 1:6 ADMIRAL RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758
Practice Address - Country:US
Practice Address - Phone:516-541-1360
Practice Address - Fax:516-882-2133
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003626213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASC002679LOtherPA LICENSE NUMBER
NY00787311Medicaid
PASC002679LOtherPA LICENSE NUMBER
T51125Medicare UPIN