Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | A166931 | NY |
N | 207QA0401X | Family Doctor - Addiction Medicine | A166931 | NY |
NPI | 1811056161 |
---|---|
Provider Name | Joseph Richard Ippolito |
First Address | Rockville Centre, NY 11570-1752 |
Second Address | Mineola, NY 11501-4014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E55975 | (02) |