Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 22DI00991100 | NJ |
NPI | 1689643447 |
---|---|
Provider Name | Dr. Steven Cipris |
First Address | Rivervale, NJ 07675-6510 |
Second Address | Ridgewood, NJ 07450-3956 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U24755 | (02) | NJ |