Basic Information
| Provider Information | |||||||||
| NPI: | 1679635965 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAPAN | ||||||||
| FirstName: | LEVON | ||||||||
| MiddleName: | MISAK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 DYER CT | ||||||||
| Address2: | |||||||||
| City: | NORWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076482308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2017674066 | ||||||||
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| Practice Location | |||||||||
| Address1: | 462 1ST AVE | ||||||||
| Address2: | NB 11N34 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100169196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125236571 | ||||||||
| FaxNumber: | 2122638743 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207L00000X | 122150 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 02113000 | 05 | NY | MEDICAID |