Organization
DOMICIANO V. CAPITLY, M.D.
Active
Other names
Park Avenue Primary Medical
Organization subpart
No
Provider details
NPI number
Authorized official
DOMICIANO V CAPITLY M.D. (MEDICAL DOCTOR)
(908) 561-3934
Entity
Organization
Contact information
Practice address
1907 PARK AVE, SUITE 203, SOUTH PLAINFIELD, NJ 07080-5530
(908) 561-3934
(908) 561-6881
Mailing address
1907 PARK AVE, SUITE 203, SOUTH PLAINFIELD, NJ 07080-5530
(908) 561-3934
(908) 561-6881
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0722804
—
NJ
Enumeration date
05/24/2007
Last updated
10/11/2013
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