1063417327 NPI number — DR. ANTHONY CIPOLLA MD

Table of content: DR. ANTHONY CIPOLLA MD (NPI 1063417327)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063417327 NPI number — DR. ANTHONY CIPOLLA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CIPOLLA
Provider First Name:
ANTHONY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1063417327
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1486 DEER PARK AVE UNIT A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH BABYLON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11703-1214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-422-3200
Provider Business Mailing Address Fax Number:
631-422-6597

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1486 DEER PARK AVE UNIT A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH BABYLON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11703-1214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-422-3200
Provider Business Practice Location Address Fax Number:
631-422-6597
Provider Enumeration Date:
06/14/2005

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: 207R00000X , with the licence number:  175335 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0435421 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0976486000 . This is a "AMERIHEALTH ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: CIM175335 . This is a "NF/WC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P62369454 . This is a "MULTIPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 175335 . This is a "LICENSE #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01572247 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2505064 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 010175331NY01 . This is a "ANTHEM HEALTH ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 045244 . This is a "AETNA/US HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4331591 . This is a "AETNA ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 110227279 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1143305 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3C3154 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 08G261 . This is a "BLUE CROSS BLUE SHIELD ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 41397 . This is a "VYTRA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: CP542 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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