Basic Information
| Provider Information | |||||||||
| NPI: | 1366652919 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANTHONY CIPOLLA PHYSICIAN, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 JOHN ST | ||||||||
| Address2: | #103 | ||||||||
| City: | BABYLON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117022939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314223200 | ||||||||
| FaxNumber: | 6314226597 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 JOHN ST | ||||||||
| Address2: | SUITE #103 | ||||||||
| City: | BABYLON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117022939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314223200 | ||||||||
| FaxNumber: | 6314226597 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 10/04/2007 | ||||||||
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| AuthorizedOfficialLastName: | CIPOLLA | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6314223200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 5243093 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.