1699963462 NPI number — MR. NICHOLAS ANTHONY CIPPARONE PT

Table of content: (NPI 1023171584)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699963462 NPI number — MR. NICHOLAS ANTHONY CIPPARONE PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CIPPARONE
Provider First Name:
NICHOLAS
Provider Middle Name:
ANTHONY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

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:
1699963462
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 SECOND ST
Provider Second Line Business Mailing Address:
STE E
Provider Business Mailing Address City Name:
SWEDESBORO
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08085
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-241-2222
Provider Business Mailing Address Fax Number:
856-241-7961

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
502-503 INDEPENDENCE BLVD
Provider Second Line Business Practice Location Address:
LAKESIDE BUSINESS PARK
Provider Business Practice Location Address City Name:
SICKLERVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-629-8777
Provider Business Practice Location Address Fax Number:
856-629-8771
Provider Enumeration Date:
10/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  MPT40QA01092600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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