Healthcare Provider Details

I. General information

NPI: 1831914191
Provider Name (Legal Business Name): PIPPEN HEALTH OF NEW JERSEY, P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CHARLES EWING BLVD STE 160
EWING NJ
08628-3456
US

IV. Provider business mailing address

1023 SPRINGDALE RD # 13A
AUSTIN TX
78721-2465
US

V. Phone/Fax

Practice location:
  • Phone: 512-270-0190
  • Fax:
Mailing address:
  • Phone: 512-270-0190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JON LARSON
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 512-270-0190