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NPI Code Detail

MEDICARE: DR. PHILIPPE DESPLAT D.O.

MEDICARE: DR. PHILIPPE DESPLAT D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianMB04078200NJ

General Provider Information

NPI Number : 1033166798
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PHILIPPE DESPLAT D.O.
Provider Business Mailing Address
First Line : 40 WASHINGTON AVE
Second Line :
City : DUMONT
State : NJ
Zip : 07628-3697
Country : US
Telephone Number : 201-387-7055
Fax Number : 201-387-8605
Provider Business Practice Location Address
First Line : 40 WASHINGTON AVE
Second Line : VALLEY HEALTH MEDICAL GROUP
City : DUMONT
State : NJ
Zip : 07628-3697
Country : US
Telephone Number : 201-387-7055
Fax Number : 201-387-8605
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2006
Last Update Date : 06/03/2014

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