Healthcare Provider Details

I. General information

NPI: 1548216690
Provider Name (Legal Business Name): GEORGE KIPEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 POLIFLY RD SUITE 106
HACKENSACK NJ
07601-1758
US

IV. Provider business mailing address

155 POLIFLY RD SUITE 106
HACKENSACK NJ
07601-1758
US

V. Phone/Fax

Practice location:
  • Phone: 201-487-7617
  • Fax: 201-342-5341
Mailing address:
  • Phone: 201-487-7617
  • Fax: 201-342-5341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number25MA05145300
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier5593107
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: