Healthcare Provider Details

I. General information

NPI: 1275793739
Provider Name (Legal Business Name): KELLY RIPPEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SUMMIT AVE SUITE 105
HACKENSACK NJ
07601-8503
US

IV. Provider business mailing address

5 SUMMIT AVE SUITE 105
HACKENSACK NJ
07601-8503
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-2900
  • Fax:
Mailing address:
  • Phone: 551-996-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA08778200
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: