Provider Demographics
NPI:1053351726
Name:CAPEK, LUCIE (MD)
Entity type:Individual
Prefix:DR
First Name:LUCIE
Middle Name:
Last Name:CAPEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2490
Mailing Address - Country:US
Mailing Address - Phone:518-786-1700
Mailing Address - Fax:518-786-9241
Practice Address - Street 1:713 TROY SCHENECTADY RD
Practice Address - Street 2:SUITE 308
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2490
Practice Address - Country:US
Practice Address - Phone:518-786-1700
Practice Address - Fax:518-786-9241
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204519208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01789115Medicaid
NY01789115Medicaid
NYRB1749Medicare PIN