Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 25MB05436000 | NJ |
Y | 207QS0010X | Family Doctor - Sports Medicine | 25MB05436000 | NJ |
NPI | 1275576910 |
---|---|
Provider Name | Dr. John P Kripsak |
First Address | Bridgewater, NJ 08807-1704 |
Second Address | Bridgewater, NJ 08807-1704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 08/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1331701 | (05) | NJ |
E39954 | (02) | NJ |